An Interactive Systems Approach to Ending the HIV Epidemic Among Women in Atlanta

结束亚特兰大女性艾滋病毒流行的交互式系统方法

• 批准号: 10474558
• 负责人: JESSICA A SALES
• 金额: $ 66.22万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474558
• 关键词: AIDS prevention; Address; Adoption; Affect; Area; Awareness; Caring; Client; Clinic; Collaborations; Communities; Community Health; Contraceptive methods; Counseling; County; Coupled; Data; Development; Dissemination and Implementation; Ensure; Epidemic; Family Planning; Family Planning Programs; Federally Qualified Health Center; Funding; Grant; HIV; HIV diagnosis; Human Papilloma Virus Vaccine; Human Papillomavirus; Human immunodeficiency virus test; Interactive Systems Framework; Methodology; Methods; Modeling; Patients; Positioning Attribute; Process; Provider; Research; Risk; Sales; Sexual Health; Side; Site; System; Training; Trust; Voice; Woman; Women' s Health; Work; base; care delivery; care seeking; cis-female; collaborative approach; community engagement; evidence base; human centered design; implementation research; implementation science; implementation strategy; improved; innovation; interest; member; patient oriented; patient-level barriers; pre-exposure prophylaxis; provider-level barriers; satisfaction; scale up; screening; social stigma; uptake; usability

ABSTRACT Supply and demand constraints have affected PrEP scale-up for cisgender women in the Southern US. PrEP use requires ensuring that cisgender women who can benefit from PrEP are aware of it (i.e., demand side) and ensuring PrEP is accessible in settings where cisgender women seek care (i.e., supply side). Anchoring PrEP care to Title X-funded family planning services that cisgender women already trust, access routinely, and deem useful for their sexual health is of great appeal, as it offers an ideal opportunity to reach women who may benefit from PrEP. In Georgia, the state with the highest rate of new HIV diagnoses, our work demonstrates that many Title X family planning clinics do not provide PrEP. Our research also shows low PrEP awareness and use among Atlanta cisgender women. Further, our Atlanta-based family planning-focused PrEP implementation research indicates that even when FP clinics offer PrEP, few cisgender women uptake PrEP, and providers note continued discomfort with screening, recommending and counseling about PrEP. Lessons learned from HPV vaccine and contraception rollout demonstrates that awareness and availability alone may not be sufficient; moving cisgender women from PrEP awareness to uptake demands alternative delivery models, inclusive of women's perspectives, to overcome other factors impeding women from using PrEP. Improving PrEP reach among cisgender women may therefore require more effectively engaging them in the development of appropriated and acceptable patient-centered PrEP care approaches to support uptake. In the proposed project, we will (Aim 1) use the Interactive Systems Framework to employ tailored implementation strategies informed by our extensive prior work to support PrEP adoption and implementation across Atlanta Title X clinics (addressing supply-side barriers); (Aim 2) use an evidence-based Community Organizing Approach to raise awareness, interest, and connection to PrEP among cisgender women (addressing demand- side barriers); and (Aim 3) innovatively use human centered design (HCD), a patient-centered methodology that brings bringing end-users and developers together to co-create care delivery strategies, to bring Southern women's voices into the development of PrEP care delivery strategies. Given limited research pertaining to strategies to increase PrEP reach among cisgender women in the South, findings from each aim will independently fill numerous gaps for optimizing clinic and community strategies to strengthen HIV prevention for Southern women. Given our collaboration with Georgia Family Planning System (Georgia's Title X grantee), Atlanta area Title X clinics, and robust partnerships with sexual health CBOs (led by SisterLove), we are uniquely positioned to mount a coordinated approach across diverse Atlanta counties built around our clinic- academic-CBO collaboration to strengthen HIV prevention for women, and importantly, to create a sustainable systems approach to move new HIV prevention (and sexual health) innovations more quickly to women.

抽象的 供求限制影响了美国南部的cisgender妇女的准备规模。准备 使用需要确保可以从PREP中受益的Sisgendend妇女意识到这一点（即需求方）和 确保在Scisgender妇女寻求护理（即供应方面）的环境中可以使用准备。锚定准备 关心X级资助的计划生育服务，Cisgender妇女已经定期信任，访问和DEEM 对于他们的性健康有用，非常吸引人，因为它提供了一个理想的机会，可以接触可能 从准备中受益。在佐治亚州，新的HIV诊断率最高的州，我们的工作证明了 许多标题X的计划生育诊所无法提供准备。我们的研究还显示了较低的准备意识 并在亚特兰大的西格德妇女中使用。此外，我们总部位于亚特兰大的计划计划中心的预备 实施研究表明，即使FP诊所提供准备，也很少有Cisgender女性吸收准备 提供者注意到，对筛查，推荐和咨询有关PREP的持续不适。教训 从HPV疫苗和避孕推出中学到的 不够；将Cisgender妇女从准备意识转移到吸收需要替代交付 包括女性观点的模型，以克服阻碍妇女使用Prep的其他因素。 因此，提高赋形剂妇女之间的准备范围可能需要更有效地使她们参与 开发以患者为中心且可接受的以患者为中心的预备护理方法来支持摄取。在 提议的项目，我们将（AIM 1）使用交互式系统框架采用量身定制的实施 通过我们广泛的先前工作来支持的策略，以支持亚特兰大的准备和实施 标题X诊所（解决供应方障碍）； （目标2）使用基于证据的社区组织 提高赋形书妇女中对准备的认识，兴趣和联系的方法（解决需求 - 侧面屏障）； （AIM 3）创新使用以患者为中心的方法的人类以人为中心的设计（HCD） 这使最终用户和开发人员聚集在一起，共同创建护理交付策略，使南方 妇女的声音是制定准备策略的发展。鉴于与 在南方的cisgender妇女中增加准备范围的策略，每个目标的发现将 独立填补许多空白，以优化诊所和社区策略以增强艾滋病毒的预防 对于南方妇女。鉴于我们与佐治亚州计划生育系统（佐治亚州的标题X受赠人）的合作， 亚特兰大地区的标题X诊所，以及与性健康CBO（由Sisterlove领导）的强大合作伙伴关系，我们是 独特的位置，可以在我们的诊所周围建立的各种亚特兰大县采用协调的方法 - 学术-CBO合作，以加强女性预防艾滋病毒的预防，重要的是创造可持续性 对女性更快地转移新的HIV预防艾滋病毒（和性健康）创新的系统方法。