Preference for and Efficacy of a PrEP Decision Aid for Women with Substance Use Disorders

Figures & data

Figure 1 CONSORT Flow Diagram of Participant Allocation.

Figure 2 Longitudinal PrEP Outcomes by Study Arm (N=164).

Abbreviation: eSOC, enhanced standard of care.

Table 1 Baseline Characteristics of the Study Sample by Arm (N=164)

Characteristic	Total Sample N=164	Decision Aid N=83	eSOC N=81	p-value
Mean age, SD	40.4 (10.3)	40.4 (10.4)	40.4 (10.3)	0.96
Race				0.69
White	123 (75.0)	62 (74.7)	61 (75.3)
Black	26 (15.9)	12 (14.5)	14 (17.3)
Other	15 (9.2)	9 (10.8)	6 (7.4)
Ethnicity				0.84
Hispanic	17 (10.4)	9 (10.8)	8 (9.9)
Non-Hispanic	147 (89.6)	74 (89.2)	73 (9.1)
Education completed				0.55
Less than high school	31 (18.9)	18 (21.7)	13 (16.1)
High school	73 (44.5)	34 (41.0)	39 (48.2)
More than high school	60 (36.6)	31 (37.4)	29 (35.8)
Median monthly income, IQR	793 (798)	871 (842)	700 (753)	0.48
Employment Status				0.21
Full time	74 (15.1)	32 (38.6)	42 (51.9)
Part time	37 (22.6)	20 (24.1)	17 (21.0)
Retired/Disability	17 (10.4)	12 (14.5)	5 (6.2)
Unemployed	36 (22.0)	19 (22.9)	17 (21.0)
Marital status	N=163	N=83	N=80	0.21
Married	36 (22.1)	15 (18.1)	21 (26.3)
Not/never married	127 (77.9)	68 (81.9)	59 (73.8)
Past 3-year living arrangement				0.63
Alone	18 (11.0)	11 (13.3)	7 (8.6)
Controlled/Unstable	14 (8.5)	6 (7.2)	8 (9.9)
With family/friends/parents	38 (23.2)	17 (20.5)	21 (25.9)
With children/partner	94 (57.3)	49 (59.0)	45 (55.6)
Past 30d housing status	N=118	N=61	N=57	0.37^a
House/apartment	87 (73.7)	78 (78.7)	39 (68.4)
Unstable/Transitional	24 (20.3)	10 (16.4)	14 (25.5)
Controlled setting	7 (5.9)	3 (4.9)	4 (7.0)
Last healthcare provider visit				0.91
Within past year	131 (79.9)	66 (79.5)	65 (80.3)
More than 1 year prior	33 (20.1)	17 (20.5)	16 (19.8)
Mean Addiction Severity score, SD
Alcohol	0.04 (0.13)	0.07 (0.17)	0.02 (0.06)	0.02
Drugs	0.16 (0.17)	0.17 (0.17)	0.16 (0.16)	0.62
Severe lifetime alcohol use	14 (8.5)	11 (13.3)	3 (3.7)	0.03^a
Severe lifetime drug use	88 (53.7)	46 (55.4)	42 (51.9)	0.65
Hazardous drinking	52 (31.7)	26 (31.3)	26 (32.1)	0.92
Mean Psychiatric Severity score, SD	0.33 (0.25)	0.35 (0.25)	0.32 (0.24)	0.44
Severe lifetime psychiatric issue	111 (67.7)	57 (68.7)	54 (66.7)	0.78
Type of substance use disorder
Alcohol use disorder	23 (14.0)	14 (16.9)	9 (11.1)	0.29
Opioid use disorder	151 (92.1)	76 (91.6)	75 (92.6)	0.81
Cocaine use disorder	69 (42.1)	32 (38.6)	37 (45.7)	0.36
Psychiatric disorders
Bipolar disorder	31 (18.9)	16 (19.3)	15 (18.5)	0.90
Anxiety disorder	63 (38.4)	36 (43.4)	27 (33.3)	0.19
PTSD	47 (28.7)	27 (32.5)	20 (24.7)	0.27
Major depressive disorder	47 (28.7)	29 (34.9)	18 (22.2)	0.07
Experienced trauma	N=102	N=51	N=51
Physical assault	68 (66.7)	35 (68.6)	33 (64.7)	0.67
Assault with weapon	29 (28.4)	14 (27.5)	15 (29.4)	0.83
Sexual assault	53 (52.0)	25 (49.0)	28 (54.9)	0.55
Mean BASIS-24 score (SD)	N=122	N=63	N=59
Overall score	1.67 (0.75)	1.69 (0.74)	1.65 (0.77)	0.77
Depression/functioning	2.08 (1.03)	2.11 (1.03)	2.05 (1.53)	0.74
Relationships	1.56 (0.90)	1.68 (0.95)	1.43 (0.84)	0.13
Self-Harm	0.35 (0.64)	0.32 (0.55)	0.38 (0.72)	0.62
Emotional Lability	1.90 (1.00)	1.94 (0.97)	1.86 (1.00)	0.67
Psychosis	0.53 (0.89)	0.49 (0.85)	0.57 (0.93)	0.60
Substance Abuse	2.25 (1.13)	2.15 (1.13)	2.36 (1.12)	0.31
Mean Self-efficacy (SD)	N=86	N=44	N=42
	29.1 (5.8)	29.1 (6.0)	29.1 (5.7)	0.97
Mean Social Support score, SD	73.5 (23.7)	70.8 (25.1)	76.3 (22.0)	0.14
Main source of social support	n=162	n=82	n=80
Partner	49 (30.3)	23 (28.1)	26 (32.5)	0.54
Family	67 (41.4)	34 (41.5)	33 (41.3)	0.98
Community/church	11 (6.8)	7 (8.5)	4 (5.0)	0.53^a
Other	9 (5.6)	5 (6.1)	4 (5.0)	1.0
No one	9 (5.6)	6 (7.3)	3 (3.8)	0.50
Mean no. lifetime arrests (SD)	N=163	N=83	N=80	0.09
	3.8 (8.8)	4.9 (11.7)	2.7 (4.3)
Mean months lifetime incarceration (SD)	9.6 (29.3)	9.5 (25.9)	9.7 (32.6)	0.95

Note: ^aFisher's exact test.

Abbreviations: eSOC, enhanced standard of care; SD, standard deviation; IQR, interquartile range; PTSD, post-traumatic stress disorder; ASI, addiction severity index for psychiatric disorders (-P) and depression (-D).

Table 2 HIV Risk and PrEP Interest by Study Arm (N=164)

Characteristic	Total Sample N=164	Decision Aid N=83	eSOC N=81	p-value
Mean categories HIV risk behaviors (SD)	2.3 (2.0)	2.5 (2.1)	2.0 (1.8)	0.16
Baseline HIV risk perception for acquiring HIV	N=155	N=78	N=77	0.01
Somewhat/extremely likely	28 (18.1)	20 (25.6)	8 (10.4)
Unlikely/not at all	127 (81.9)	58 (74.4)	69 (89.6)
Baseline PrEP eligible	85 (51.8)	47 (56.6)	38 (46.9)	0.21
Underestimate risk	58 (37.4)	28 (35.9)	30 (39.0)	0.69
PrEP interest – pre-selection				0.05
No	9 (5.5)	1 (1.2)	8 (9.9)
Yes	41 (25.0)	21 (25.3)	20 (24.7)
Ambivalent	114 (69.5)	61 (73.5)	53 (65.4)
PrEP interest – post-decision aid	n/a		n/a	n/a
Likely/very likely		74 (89.2)
Unlikely/not at all		9 (10.8)
Most important factor influenced by decision aid	n/a		n/a
Personal risk		11 (6.7)
Effective at preventing HIV		44 (26.7)
How it works		5 (3.0)
Insurance coverage		1 (0.6)
Side effects		11 (6.7)
What is involved		2 (1.2)
Medication interactions		6 (3.6)
Other		3 (1.8)

Abbreviation: eSOC, enhanced standard of care.

Table 3 Bivariate and Independent Correlates for Selecting for More Information Using a Decision Aid

Variables	Bivariate Analysis		Multivariate Analysis
	Decision Aid OR (95% CI)	p-value	Decision Aid aOR (95% CI)	p-value
Age	0.99 (0.97, 1.03)	0.96
Race		0.69
White	REF
Black	0.84 (0.36, 1.97)
Other	1.48 (0.50, 4.40)
Hispanic	1.11 (0.41, 3.03)	0.84
Marital status		0.21
Married	REF
Not/never married	0.62 (0.29, 1.31)
Past 3-year living arrangement		0.63
Alone	REF
Controlled/Unstable	0.48 (0.12, 1.98)
With family/friends	0.52 (0.16, 1.62)
With children/partner	0.69 (0.25, 1.94)
Education completed		0.55
Less than high school	REF
High school	0.63 (0.27, 1.47)
More than high school	0.77 (0.32, 1.85)
Last healthcare provider visit within past year	0.96 (0.45, 2.05)	0.91
Alcohol use disorder	1.62 (0.66, 3.99)	0.29
Lifetime severe alcohol use	3.97 (1.07, 14.81)	0.04	4.13 (1.05, 16.28)	0.04
Cocaine use disorder	0.75 (0.40, 1.39)	0.36
Anxiety	1.53 (0.81, 2.89)	0.19	1.87 (0.94, 3.70)	0.07
PTSD	1.47 (0.74, 2.91)	0.27
BASIS-24 – relationships domain	1.37 (0.94, 2.05)	0.13
Social support	0.99 (0.98, 1.00)	0.14	0.99 (0.98, 1.01)	0.32
Underestimate HIV risk	0.88 (0.46, 1.68)	0.69
PrEP eligible	1.48 (0.80, 2.73)	0.21
High perceived HIV risk	2.97 (1.22, 7.25)	0.02	2.95 (1.19, 7.35)	0.02
PrEP ambivalence	1.47 (0.75, 2.86)	0.26

Abbreviations: OR, odds ratio; aOR, adjusted odds ratio; PTSD, post-traumatic stress disorder.