Centering Those Engaged in Transactional Sex: A PrEP Innovation for Getting To Zero

以从事性交易的人为中心：实现零风险的 PrEP 创新

基本信息

批准号：
10543635
负责人：
Randi Beth Singer
金额：
$ 16.61万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-04 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10543635
关键词：
AIDS prevention Address Adherence Adopted Adoption California Chicago Client Clinic Collaborations Communities Community Services Country Discrimination Drops Education Educational Curriculum Effectiveness of Interventions Evaluation Evaluation Methodology Exploration Preparation Implementation and Sustainment Federally Qualified Health Center Fostering Foundations Future General Population Goals HIV HIV Infections HIV Seronegativity HIV risk HIV/STD Harm Reduction Health Health Promotion Health system Healthcare Healthcare Systems Illinois Individual Infection Information Services Intention Intervention Intervention Studies Interview Knowledge Lead Leadership Learning Skill Link Location Mediation Mentors Methods Modeling Nurses Outcome Participant Patient Care Patients Pilot Projects Population Populations at Risk Positioning Attribute Postpartum Period Pregnant Women Prenatal care Preparation Prevalence Prevention Process Prophylactic treatment Provider Qualitative Research Randomized Randomized Controlled Trials Research Research Design Research Training Risk STI prevention San Francisco Scanning Science Scientist Self Efficacy Self Management Services Site Strategic Planning Structure Surveys Target Populations Testing Time Training United States National Institutes of Health Universities Visit Walking Work acceptability and feasibility arm career development cohort community building condoms design educational atmosphere effectiveness implementation trial effectiveness study empowered empowerment evidence base experience hands-on learning health assessment health care delivery health care model health care service high risk implementation barriers implementation determinants implementation facilitators implementation framework implementation process improved innovation marginalized population patient oriented patient population pill pilot trial post intervention pre-exposure prophylaxis prevent public health priorities recruit research study scale up sex skills social health determinants social stigma sustainability framework therapy design

项目摘要

Getting to Zero (GTZ) new HIV infections by 2030 is a public health priority. Increasing HIV prevention, self- management, and harm reduction among at-risk populations is critical. HIV prevalence in sex workers is 12 times greater than the general population, highlighting the need for targeted prevention efforts. Increasing optimal use of pre-exposure prophylaxis (PrEP) in this population will advance progress toward GTZ 2030. Community empowerment interventions reduce HIV risk among sex workers because interventions are collaboratively designed, implemented, and evaluated by the target population. A community-empowered PrEP navigation approach may be feasible and acceptable among sex workers. One such approach is a group healthcare model called Centering Healthcare (Centering), which originated as a group prenatal care model and has since been modified for various patient populations. Centering's three core components: healthcare, interactive learning, and community building, disrupt typical healthcare power hierarchies by creating a respectful and collaborative interactive learning environment that honors group needs. The model's positive impact links self-management goals and health assessment with interactive activities to foster health promotion. Using an implementation science framework and building on Centering intervention effectiveness, this study will be the first to evaluate whether Centering is feasible and acceptable for PrEP education, navigation, and adherence among sex workers. Preliminary qualitative research with 39 sex workers in Chicago highlighted that stigma and healthcare discrimination dissuaded sex workers from regularly accessing HIV prevention information, services, and treatment. In collaboration with sex workers and a Community Advisory Board (CAB), we culturally adapted the Centering curriculum and facilitator's guide to meet the stated needs of sex workers. Guided by an Exploration, Preparation, Implementation, Sustainment framework (EPIS), the overall goal of this study is to expand on my formative research and evaluate if this culturally adapted Centering PrEP (C-PrEP+) model is feasible and acceptable for addressing education, navigation and PrEP adherence needs of HIV negative sex workers in Chicago. Specific aims of this study are to 1. Produce an implementation plan for integrating C-PrEP+ into a Federally Qualified Health Care (FQHC) system. 2. Conduct a pilot feasibility and acceptability trial of C-PrEP+. 3. Complete an evaluation of C-PrEP+ to document implementation barriers and facilitators. The research plan will be augmented by expert mentoring and didactic research training at University of Illinois Chicago and University of California San Francisco. This proposal, mentoring, and coursework will provide essential career development in: 1. Quantitative methods, 2. Health intervention study design, preparation, implementation, and 3. Mixed-methodological evaluation. This foundation will uniquely position the PI to lead a fully powered multi-site RCT to determine if C-PrEP+ is an efficacious and sustainable model to address HIV prevention among sex workers.

到 2030 年实现新艾滋病毒感染为零 (GTZ) 是一项公共卫生优先事项。加强艾滋病毒预防、自我预防管理和减少高危人群的伤害至关重要。性工作者的艾滋病毒感染率为 12 是一般人口的数倍，凸显了有针对性的预防工作的必要性。增加在这一人群中优化使用暴露前预防 (PrEP) 将推动 GTZ 2030 的进展。社区赋权干预措施可降低性工作者的艾滋病毒风险，因为干预措施由目标人群协作设计、实施和评估。社区授权的 PrEP 导航方法对于性工作者来说可能是可行和可接受的。其中一种方法是团体医疗保健模式称为居中医疗（Centering），起源于团体产前保健模式并针对不同的患者群体进行了修改。 Centering 的三个核心组成部分：医疗保健、互动学习和社区建设通过创建一个尊重群体需求的尊重和协作的互动学习环境。模型的积极性影响力将自我管理目标和健康评估与促进健康的互动活动联系起来晋升。使用实施科学框架并以中心干预为基础有效性，这项研究将是第一个评估居中是否可行和可接受的研究性工作者的 PrEP 教育、引导和依从性。初步定性研究 39 芝加哥的性工作者强调，耻辱和医疗保健歧视阻碍了性工作者定期获取艾滋病毒预防信息、服务和治疗。与性工作者合作以及社区咨询委员会（CAB），我们在文化上调整了中心课程和辅导员指南满足性工作者的既定需求。以探索、准备、实施、维持为指导框架（EPIS），这项研究的总体目标是扩展我的形成性研究并评估这是否适应文化的中心 PrEP (C-PrEP+) 模式对于解决教育问题是可行且可接受的，芝加哥 HIV 阴性性工作者的导航和 PrEP 依从性需求。本研究的具体目标是 1. 制定将 C-PrEP+ 纳入联邦合格医疗保健 (FQHC) 的实施计划系统。 2. 进行C-PrEP+的试点可行性和可接受性试验。 3. 完成 C-PrEP+ 评估记录实施障碍和促进因素。该研究计划将通过专家指导得到加强并在伊利诺伊大学芝加哥分校和加州大学旧金山分校进行教学研究培训。这提案、指导和课程作业将在以下方面提供必要的职业发展：1. 定量方法，2. 健康干预研究的设计、准备、实施，以及 3. 混合方法学评估。这基金会将以独特的方式让 PI 领导一项全面的多中心随机对照试验，以确定 C-PrEP+ 是否是一种解决性工作者艾滋病毒预防问题的有效且可持续的模式。