PrEP Pro: Adapting a multi-component intervention to train and support providers to promote PrEP for adolescent girls and young women in the Deep South

PrEP Pro：采用多成分干预措施来培训和支持提供者，以促进南部腹地少女和年轻女性的 PrEP

• 批准号: 10469666
• 负责人: Latesha Ellen Elopre
• 金额: $ 22.28万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 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/10469666
• 关键词: Acquired Immunodeficiency Syndrome; Administrator; Adolescent; Adult; African American; Alabama; Anti-Retroviral Agents; Attitude; Behavior; Behavioral Model; Black Populations; Black race; Caring; Client; Clinic; Collaborations; Communities; Consolidated Framework for Implementation Research; Data; Deep South; Education; Educational Curriculum; Enrollment; Epidemic; Epidemiology; Event; Evidence based intervention; Family Practice; Feedback; Female; Female Adolescents; Focus Groups; Funding; Future; Gender; HIV; HIV Infections; HIV-infected adolescents; HIV/STD; Health Knowledge Attitudes Practice; Health Personnel; Health Services Accessibility; Health Services Research; High Risk Woman; Hybrids; Incidence; Infection; Insurance; Intervention; Interview; Knowledge; Measures; Medical Education; Methods; Motivation; Oral; Outcome; Participant; Pattern; Persons; Pharmaceutical Preparations; Physicians; Policy Maker; Population; Positioning Attribute; Primary Health Care; Provider; Qualitative Methods; Recording of previous events; Research; Risk; Role; Rural; Science; Scientist; Screening procedure; Sexual Health; Sexual Transmission; Sexuality; Surveys; Techniques; Tenofovir; Testing; Time; Training; Training Programs; Training Support; United States National Institutes of Health; Woman; Work; acceptability and feasibility; adolescent health; base; behavior change; care providers; cis-female; cisgender; clinical care; community engaged research; effectiveness implementation study; effectiveness implementation trial; evidence base; family support; formative assessment; implementation determinants; improved; intervention mapping; men; multi-component intervention; peer support; pilot test; pilot trial; post intervention; pre-exposure prophylaxis; primary outcome; provider behavior; provider intervention; research and development; risk perception; rural families; rural healthcare; screening; skills; social stigma; therapy development; tool; uptake; young woman

Narrative/Abstract Black adolescent girls and young women (AGYW) are at high-risk for HIV acquisition. Antiretroviral medication for pre-exposure prophylaxis (PrEP) is an effective, female-controlled strategy to dramatically reduce HIV-acquisition risk, but uptake is low. With funding from an Ending the HIV Epidemic (EtHE) supplement to the UAB Center for AIDS Research, we surveyed and interviewed health care providers working in Alabama. Our data suggest that providers do not consider prescribing PrEP to Black AGYW. Important barriers include client, provider, and community stigma around sexuality, challenges of obtaining a sexual history, limited training on PrEP indications and management, and structural limitations related to insurance. Using the Intervention Mapping, and the Capability-Opportunity-Motivation-Behavior model for behavioral change, we propose to adapt evidence-based curriculum on HIV epidemiology, PrEP indications and efficacy; skills building and client-facing tools for obtaining sexual histories; and provider PrEP Champions to create a multi-component context-specific provider intervention, PrEP-Pro. In Aim 1, we will adapt PrEP-Pro to Family Medicine trainees due to their role in caring for adolescents at stages of transition and substantial contributions to rural healthcare. We focus on residents in training to leverage trainee mindset and energy while seeding the Family Medicine workforce with PrEP informed providers. We will convene an advisory board of providers, PrEP Champions, AGYW, and clinic administrators to adapt existing content to the local context. We will solicit feedback on PrEP-Pro content from providers and AGYW through focus group discussions. In Aim 2, we will pre-test the adapted PrEP-Pro content with up to 12 Family Medicine residents and 2 PrEP Champions in rural and urban AL and further hone PrEP-Pro based on their feedback via surveys and in-depth interviews. We will then conduct an open pilot with 60 Family Medicine residents. Primary pilot outcomes are acceptability and feasibility. We will also measure PrEP knowledge and attitudes as well as PrEP prescribing patterns and HIV/STI testing in the 6-month periods pre- and post-intervention. In Aim 3 we will elucidate determinants to PrEP-Pro implementation by conducting in-depth interviews with providers, AGYW, and other key stakeholders, reviewing findings with our CAB, and seeking additional input through dissemination events to inform a future hybrid effectiveness/implementation trial. With expertise in adolescent health, sexual health, adult medical education, PrEP, qualitative methods, community-engaged research, and intervention development and a team led by women and African-American clinician-scientists who work, live, teach, and provide care in the Deep South, we are well-positioned to complete the proposed science, disseminate information to key stakeholders and policy makers, and apply these data to inform interventions to mitigate HIV for AGYW in the Deep South.

叙述/抽象 黑人青春期女孩和年轻女性（AGYW）处于高风险中以获得艾滋病毒。抗逆转录病毒 预防前的药物（PREP）是一种有效的女性控制的策略 降低艾滋病毒的风险，但吸收较低。结束艾滋病毒流行（ETHE）的资金 补充UAB艾滋病研究中心，我们调查并采访了医疗保健提供者 在阿拉巴马州。我们的数据表明，提供者不考虑为Black Agyw处方准备。重要的 障碍包括围绕性行为的客户，提供者和社区污名，获得性的挑战 历史记录，有关准备指示和管理的培训有限，以及与保险有关的结构限制。 使用干预映射，以及功能 - 企业动机行为模型 行为改变，我们建议将基于证据的课程适应HIV流行病学，准备指示 和功效；建立技能和面向客户的工具，用于获得性历史；和提供者准备冠军 为了创建一个多组件上下文特定的提供商干预措施，Prep-Pro。在AIM 1中，我们将适应Prep-Pro 由于他们在过渡阶段照顾青少年的角色，因此向家庭医学学员致敬 对农村医疗保健的贡献。我们专注于培训中的居民，以利用受训者的心态和精力 同时，将家庭医学劳动力与准备好知情的提供者一起播种。我们将召开一个顾问委员会 提供者，预备冠军，AGYW和诊所管理员的掌握，以使现有内容适应当地环境。 我们将通过焦点小组讨论对提供商和AGYW的Prep-Pro内容征求反馈。在 AIM 2，我们将预先测试改编的Prep-Pro含量，最多12个家庭医学居民和2个PREP 根据他们的反馈和深入的反馈，在农村和城市的AL冠军以及进一步的磨练专家 访谈。然后，我们将与60名家庭医学居民进行公开飞行员。主要试点结果是 可接受性和可行性。我们还将衡量准备知识和态度以及准备处方 在干预前和干预后的6个月期间，模式和HIV/STI测试。在AIM 3中，我们将阐明 通过对提供商，AGYW和其他的深入访谈来实施PRO-PRO实施的决定因素 主要利益相关者，用我们的出租车审查发现，并通过传播事件寻求额外的意见 告知未来的混合有效性/实施试验。 具有青少年健康，性健康，成人医学教育，预备，定性方法方面的专业知识， 社区参与研究和干预发展以及由妇女和非裔美国人领导的团队 在南方深处工作，生活，教导和提供护理的临床医生 - 科学家，我们很适合 完成拟议的科学，将信息传播给主要的利益相关者和政策制定者，并申请 这些数据旨在为干预措施提供干预，以减轻南部深处的AGYW的艾滋病毒。