Physician Attitudes toward New Biomedical HIV Prevention Interventions in Youth

医生对青年新的生物医学艾滋病毒预防干预措施的态度

• 批准号: 8540552
• 负责人: Tanya L. Kowalczyk Mullins
• 金额: $ 13.11万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-19 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8540552
• 关键词: 21 year old; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adolescent Medicine; Adolescent Medicine Trials Network; Adopted; Adult; Advisory Committees; Affect; Anti-Retroviral Agents; Area; Attitude; Automobile Driving; Basic Science; Behavior; Behavioral; Caring; Childhood; Clinical; Clinical Investigator; Clinical Research; Committee Members; Complement; Counseling; Data; Data Collection; Development; Development Plans; Diffusion of Innovation; Effectiveness; Environment; Epidemiology; Ethics; Faculty; Funding; Future; Goals; Grant; HIV; Health; Healthy People 2020; Human immunodeficiency virus test; Incidence; Individual; Infection; Infection prevention; Intention; International; Intervention; Intervention Studies; Interview; Journals; K-Series Research Career Programs; Knowledge; Light; Local Microbicides; Manuscripts; Master of Science; Medical; Medical center; Mentors; Mentorship; Methods; New Agents; Oral; Outcome; Pediatric Hospitals; Pharmaceutical Preparations; Phase; Physician' s Role; Physicians; Planning Theory; Play; Policies; Preparation; Prevention; Prevention Measures; Prevention strategy; Preventive; Preventive Intervention; Primary Care Physician; Primary Health Care; Primary Prevention; Prophylactic treatment; Public Health; Publishing; Qualitative Methods; Recommendation; Reproductive Health; Research; Research Infrastructure; Research Methodology; Research Personnel; Research Training; Resource Development; Role; Sampling; Sexual Health; Sexually Transmitted Diseases; Structure; Survey Methodology; Surveys; Testing; Training; United States; United States National Institutes of Health; Validation; Virus Diseases; Work; Youth; age group; base; career; career development; design; experience; health disparity; improved; medical specialties; meetings; member; microbicide; novel; pediatrician; prevent; prevention service; programs; public health relevance; skills; theories; therapy design; uptake; vaginal microbicide; young adult

DESCRIPTION (provided by applicant): Between 2006 and 2009, the incidence of human immunodeficiency virus (HIV) infections increased significantly among adolescents and young adults. Although new biomedical primary prevention agents such as microbicides and pre-exposure prophylaxis (PrEP) decrease rates of HIV acquisition in trials, their effective-ness in practice will depend largely on clinician recommendations. However, despite the recent FDA approval of the first oral PrEP agent, data are not available regarding physician knowledge and attitudes about these methods with regard to use in youth. Physician intention to recommend these agents to adolescents, which is likely to be a powerful predictor of actual recommendations, is also unknown. This lack of data is a significant problem because the information will be critical to the design of interventions to improve the rate at which physicians recommend these agents to adolescents, an age group disproportionately affected by HIV infection. Dr. Mullins's long-term goal is to decrease HIV acquisition among adolescents through an independent research career focusing on the successful dissemination and uptake of new biomedical prevention agents. The candidate has demonstrated strong potential to conduct research. She has been the first-author for 5 pri- mary research manuscripts published in high-impact pediatric journals and presented her findings at national and international research meetings. She developed basic research skills through coursework culminating in a Master of Science in Epidemiology/Clinical Research. The overall objective of this K23 application, which is the next step toward attainment of the candidate's long-term goal, is to define the factors that influence physician intention to recommend microbicides and PrEP to adolescents. The central hypothesis is that physicians will have low intention to recommend microbicides and PrEP to adolescents, and factors such as knowledge, cur- rent HIV prevention practices, attitudes, subjective norm, and structural/policy factors will influence these inten- tions. The rationale underlying the proposed research is that, once the factors that influence intention to rec- ommend new agents are understood, such information can be used to design interventions that accelerate recommendations for new HIV prevention agents among clinicians who care for adolescents, which in turn will decrease adolescent HIV acquisition. The proposed research involves primary data collection using a mixed methods approach to explore and quantify physician attitudes toward and intentions to recommend new bio- medical HIV prevention agents to youth and to identify factors associated with these intentions. In the first phase, individual interviews will be conducted with 40 physicians who provide primary care to adolescents in order to explore and define the salient attitudes. The findings from this phase will inform the development of a new, validated survey designed to quantify physician attitudes and intentions with regard to recommending and prescribing microbicides and PrEP to adolescents for HIV prevention. In the final phase, the new survey will be administered to a national sample of 2500 physicians who provide primary care to adolescents to assess inten- tions to recommend and prescribe microbicides and PrEP and define predictors of these intentions. The pro- posed research will contribute novel information regarding the factors that influence physician intention to rec- ommend new prevention agents. The results will inform tailored interventions to educate physicians about these agents in order to maximize adolescent HIV prevention efforts and also will be applicable in the devel- opment of interventions to improve dissemination of other HIV prevention measures in development. In order to achieve her long-term career goal and the objectives of this application, the candidate will require training in mixed methods research (including qualitative and survey methods), health disparities, eth- ics of sexual health research, use of antiretroviral medications, and design/implementation of intervention stud- ies. These needs will be met through a combination of strong mentorship, didactics, and clinical experience. The mentorship team includes researchers with expertise in relevant content areas and mentoring junior facul- ty. Dr. Jessica Kahn, the primary mentor, provides expertise in prevention of sexually transmitted infections in adolescents and methodologic expertise in (1) the assessment of physician intentions to recommend STI pre- vention agents and (2) qualitative and survey research methods. She holds current R01 funding and is an ac- tive investigator and leader in the Adolescent Medicine Trials Network for HIV/AIDS Interventions. Dr. Kahn has successfully mentored many trainees and junior faculty. Her expertise will be complemented by that of the co-mentors and advisory committee members. The scientific environment at Cincinnati Children's Hospital Medical Center (CCHMC) provides an ideal setting for Dr. Mullins to achieve research independence. CCHMC has supported numerous junior investiga- tors, and 36 faculty hold NIH career development awards. The Division of Adolescent Medicine, which has seven NIH-funded faculty members and a focus on adolescent reproductive health research, had $1.7 million in grant support in 2011. The Division provides infrastructure and a wealth of intellectual resources for the de- velopment of the candidate. In summary, the candidate's demonstrated potential for research, novel research plan, relevant career development plan, excellent mentorship team, and outstanding research environment contribute to her ability to achieve research independence with the essential support provided by a K23 career development award.

描述（由申请人提供）：在2006年至2009年之间，青少年和年轻人中人类免疫缺陷病毒（HIV）感染的发生率显着增加。尽管新的生物医学预防剂，例如菌皮和暴露前预防剂（PREP）在试验中降低了HIV获取率，但其实践中的有效性将在很大程度上取决于临床医生的建议。然而，尽管FDA最近获得了第一位口服剂的批准，但对于医师知识和对这些方法的使用方面的态度尚无数据。医师的意图也未知，将这些代理商推荐给青少年，这可能是实际建议的有力预测指标。 缺乏数据是一个重要的问题，因为该信息对于提高医生的干预措施的设计至关重要 向青少年推荐这些药物，这是一个年龄组，受HIV感染影响不成比例。 穆林斯博士的长期目标是通过独立的研究职业来减少青少年的艾滋病毒收购，重点是成功地传播和吸收新的生物医学预防剂。候选人表现出强大的进行研究的潜力。她是在高影响力的小儿期刊上发表的5份Primary Research手稿的第一任作者，并在国家和国际研究会议上介绍了她的发现。她通过课程工作达到了流行病学/临床研究硕士学位，发展了基础研究技能。该K23应用程序的总体目标是实现候选人的长期目标的下一步，是定义影响医师意图推荐杀生型和为青少年准备的因素。中心假设是，医生将有较低的意图向青少年推荐微生物和准备，以及诸如知识，适应性HIV预防艾滋病毒的实践，态度，主观规范和结构/政策因素等因素将影响这些进化。拟议研究的基本原理是，一旦影响了人们强调新代理的意图的因素，这些信息就可以用于设计干预措施，以加快对青少年关心的临床医生的新艾滋病毒预防药物的建议，这又可以减少青少年艾滋病毒的收购。拟议的研究涉及使用混合方法方法收集主要数据，以探索和量化医师对年轻人对青年的新生物医学艾滋病毒预防剂的态度和意图，并确定与这些意图相关的因素。在第一阶段，将对40名医生进行个人访谈，他们为青少年提供初级保健，以探索和定义显着态度。这个阶段的发现将 告知开发一项新的，经过验证的调查，旨在量化医师的态度和意图，以推荐和开处方菌心以及对青少年预防艾滋病毒的预防。在最后阶段，新调查将对2500名医生的全国样本进行管理，这些医师为青少年提供初级保健，以评估建议和开具杀菌剂的进取，并进行准备并定义这些意图的预测指标。该研究的研究将贡献有关影响医师意图的因素的新信息。该结果将为量身定制的干预措施提供信息，以对医生进行有关这些药物的教育，以最大程度地提高青少年艾滋病毒预防工作，并且还适用于干预措施，以改善对开发中其他HIV预防措施的传播。 为了实现她的长期职业目标和本申请的目标，候选人将需要在混合方法研究（包括定性和调查方法）中进行培训，健康差异，性健康研究的伦理学，使用抗逆转录病毒药物以及设计/实施干预措施。这些需求将通过强大的指导，教学和临床经验的结合来满足。指导团队包括在相关内容领域具有专业知识的研究人员，并指导初级课程。主要导师杰西卡·卡恩（Jessica Kahn）博士提供了预防青少年性传播感染的专业知识和（1）（1）评估医师意图的方法论专业知识，以推荐STI预先定论药物以及（2）定性和调查研究方法。她拥有当前的R01资金，并且是艾滋病毒/艾滋病干预措施的青少年医学试验网络的研究人员和领导者。卡恩博士成功地指导了许多学员和初级教师。她的专业知识将由联席和咨询委员会成员的专业知识补充。 辛辛那提儿童医院医疗中心（CCHMC）的科学环境为穆林斯博士实现研究独立性提供了理想的环境。 CCHMC已支持众多初级调查，36位教职员工持有NIH职业发展奖。青少年医学部拥有七个由NIH资助的教职员工，专注于青少年生殖健康研究，在2011年获得了170万美元的赠款支持。该部门为候选人提供基础设施和大量的知识分子资源。总而言之，候选人表现出了研究的潜力，新颖的研究计划，相关的职业发展计划，出色的指导团队和出色的研究环境，这有助于她通过K23职业发展奖提供的基本支持来实现研究独立性。