Translating Science to Practice: The Development of an HIV Risk Assessment and Safety Plan for Survivors of Intimate Partner Violence and Assessment of the Instrument’s Usability and Appropriateness Among Domestic Violence Shelter Service Providers

Introduction:During the adaptation of an evidence based intervention for preventing HIV for women in domestic violence shelters, key stakeholders suggested the inclusion of an HIV risk assessment and safety plan for the target population. This study describes the development of that instrument and the assessment of its perceived usability and appropriateness as reported by domestic violence shelter service providers.

Methods: The instrument was developed based upon peer-reviewed journal articles and topical expert feedback. Directors from domestic violence shelters (n=534) located in the ten United States with the highest rates of HIV were contacted and told about the study. Eighty-nine percent of the directors reached agreed to participate in the study, which involved shelter directors and case managers reviewing the HIV risk assessment and safety plan, and answering questionnaires. The questionnaires asked about the following: 1) HIV prevention services offered at the shelter or referred to shelter clients, 2) their perceptions of the appropriateness of the addressing HIV risk within domestic violence shelters, and 3) their perceptions of the usability (i.e., acceptability, systems support, understanding, and feasibility) for the HIV risk assessment and safety plan. Sixty-one workers including 24 directors and 37 case managers/counselors, from 29 shelters located in 9 United States completed the questionnaires.

Results: The HIV risk assessment and safety plan consists of education about abused women’s risk factors for contracting HIV, a related risk assessment of those risk factors, a list of harm reduction strategies, and a personalized safety plan. While the mean ratings of shelter workers for the appropriateness of HIV services within shelters was high (M=4.86; max=6), only 36% of the workers reported referring clients to HIV/STI testing, 16% reported having implemented an HIV prevention intervention, 15% reported offering current HIV prevention services, and 38% reported providing shelter clients with HIV educational brochures. Mean scores for the Usage Rating Profile subscales for acceptability, feasibility, and understanding were average while scores for systems support indicated that respondents didn’t feel they would require support from others to implement this tool. Qualitative feedback responses about the tool will also be discussed.

Conclusions: More needs to be done to increase HIV prevention services in domestic violence shelters. This instrument was included in an adapted HIV prevention intervention for women in domestic violence shelters. This tool will be revised based upon the feedback received. Additional studies are needed to determine the impact of this tool on women’s HIV risk behaviors.