PrEP 4 Her: Developing a Novel Strategy to Implement PrEP into Women's Healthcare

PrEP 4 Her：制定将 PrEP 纳入女性医疗保健的新策略

基本信息

批准号：
10469513
负责人：
Latesha Ellen Elopre
金额：
$ 22.15万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-13 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10469513
关键词：
AIDS prevention AIDS/HIV problem Address Adoption Affect Age Alabama Appointment Area Awareness Behavior Therapy Belief Black race Caring Clinic Clinical Services Collaborations Communicable Diseases Communication Methods Communities Data Decision Making Diagnosis Effectiveness Epidemic Event FDA approved Family Planning Feedback Focus Groups Funding Gays Geographic Locations Geography Gynecologic Gynecologist Gynecology HIV HIV diagnosis Health Care Visit Healthcare Heterosexuals Improve Access Incidence Individual Interdisciplinary Study Interview Knowledge Lead Link Low income Manuscripts Medical Methodology Methods Nurses Outcome Persons Pharmacists Pharmacy facility Phase Physicians Pilot Projects Prevention Prevention strategy Primary Health Care Process Provider Psychology Reach Effectiveness Adoption Implementation and Maintenance Reproductive Health Research Research Design Research Personnel Risk Schedule Service delivery model Services Sexual Health Site Specialist Strategic Planning Surveys Techniques Time United States United States National Institutes of Health Universities Visit Vulnerable Populations Woman Women&apos s Health Work arm base behavioral economics black women care providers cis-female cisgender clinical care community engaged research data format epidemiologic data experimental study health care availability health care service health inequalities implementation determinants implementation evaluation implementation measures implementation outcomes implementation science implementation strategy implementation study implementation trial improved informant innovation intervention mapping men who have sex with men novel strategies pre-exposure prophylaxis preference programs racial minority population response routine care rural counties screening service delivery social stigma telehealth therapy development tool transmission process trend uptake

项目摘要

PROJECT SUMMARY HIV disproportionately affects Black cis-gender women, especially in the Southern United States (US). HIV pre- exposure prophylaxis (PrEP) was approved by the FDA in 2012 and is an effective prevention tool able to decrease HIV transmission up to 92% among cis-gender women. However, there has been minimal PrEP uptake among racial minority groups and inequitable utilization in the South. With implementation of behavioral interventions, primarily focused on demand creation (i.e. community distribution, scheduling PrEP appointments during events celebrating gay pride, etc.), PrEP utilization among almost all groups except Black cis-gender women has improved. Given these inequities, there is an urgent need to better understand how to improve PrEP utilization among Black cis-gender women in geographic locations with the greatest need, like the South. Black cis-gender women have significant individual-level barriers to PrEP utilization, including but not limited to low HIV/PrEP knowledge, PrEP stigma, and low perceived need. Programs to implement PrEP in Title X family planning clinics, where cis-gender women already receive routine care, provide attractive venues to improve access. However, in PrEP implementation studies at these clinic sites, while improvement in provider-knowledge and PrEP referrals occurred, PrEP uptake was still low when on-site services were not available. While more research is needed to improve PrEP access in family planning clinics that specialize in women’s healthcare, in states like Alabama, where clinics receiving Title X funding are currently not providing PrEP services, additional strategies are needed. Gynecology clinics offer an ideal setting for PrEP care as a part of routine reproductive and sexual health care. Gynecologists already provide primary health care services for many cis-gender women, oftentimes in place of a primary care provider, making this clinic setting ideal for integration of PrEP services tailored for Black women. Our implementation study is informed by compelling preliminary data from almost 800 Black cis-gender women living in Alabama using discrete choice experiment methodology, which determined their desired PrEP services would be delivered in a clinical care setting by a gynecologist, rather than telehealth or pharmacy based programs. The proposed study will pursue three specific aims: (1) Evaluate key determinants for implementation of PrEP into gynecology clinic settings through concurrent mixed-methods; (2) Develop and refine a multi-component implementation strategy to integrate PrEP in routine women’s health visits (i.e. PrEP4Her) and (3) Pilot PrEP4Her at a gynecology clinic. We will measure implementation outcomes grounded in the RE-AIM framework, incorporating constructs from Proctor et al, including: reach, efficacy, acceptability, fidelity, adoption and preliminary effectiveness. Upon completion of our proposed research, our inter-disciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research and psychology, will be primed to lead a multi-site type III implementation trial of PrEP service delivery at gynecology clinics across the South.

项目摘要艾滋病毒不成比例地影响黑色顺势性别妇女，尤其是在美国南部（美国）。艾滋病毒前预防暴露（PREP）在2012年获得FDA的批准，是一种有效的预防工具在顺式性别妇女中，降低艾滋病毒的传播高达92％。但是，有最少的准备吸收在南方的种族少数群体和可疑利用中。随着行为的实施干预措施主要集中于需求创建（即社区分发，安排预约预约在庆祝同性恋骄傲等的活动中），除黑色顺势性别以外的几乎所有群体中的准备妇女有所改善。鉴于这些不平等，迫切需要更好地了解如何改善准备像南方一样最需要的地理位置，黑人顺势性别妇女在地理位置的利用。黑色的顺式性别妇女具有明显的个人级别利用障碍，包括但不限于低艾滋病毒/准备知识，准备污名和低感知的需求。在标题X家族中实施准备的程序顺式性别妇女已经接受例行护理的计划诊所提供了有吸引力的场所来改善使用权。但是，在这些诊所地点的准备实施研究中，提供者知识的改善并且发生了准备转介，当没有现场服务时，预备吸收仍然很低。而更多需要进行研究以改善专门从事妇女医疗保健的计划生育诊所的准备访问像阿拉巴马州这样的州，目前收到标题X资金的诊所目前未提供预备服务，其他需要策略。妇科诊所为预备护理提供了理想的环境，作为常规生殖的一部分和性医疗保健。妇科医生已经为许多CIS性别妇女提供初级卫生保健服务，通常会代替初级保健提供者为黑人妇女量身定制。我们的实施研究是通过从近800个引人入胜的初步数据来告知的使用离散选择实验方法居住在阿拉巴马州的黑色顺势性别妇女，这确定了他们所需的准备服务将由妇科医生而不是远程医疗的临床护理环境提供或基于药房的计划。拟议的研究将追求三个具体目标：（1）评估关键确定词通过并发混合方法将PREP实施到妇科诊所环境中；（2）发展和完善一种多组分实施策略，以将PREP整合到常规妇女的健康访问中（即 Prep4her）和（3）在妇科诊所的Pretot Prep4her。我们将衡量实施成果扎根在Re-Aim框架中，编码Proctor等人的构造，包括：覆盖，效率，可接受性，忠诚，采用和初步有效性。我们提出的研究完成后，我们的跨学科团队，包括传染病专家，实施科学，社区参与研究以及心理学将备受启示，以领导妇科的多站点III型实施试验南部的诊所。