Intervention to Promote PrEP Awareness and Equitable Prescription among Providers

旨在提高提供者的 PrEP 意识和公平处方的干预措施

基本信息

批准号：
9267532
负责人：
Sarah K. Calabrese
金额：
$ 15.89万
依托单位：
GEORGE WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-01-01 至 2019-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9267532
关键词：
AIDS education AIDS prevention Acquired Immunodeficiency Syndrome Address Affect African American Anti-Retroviral Agents Attention Attitude Award Awareness Clinical Cognitive Science Communities Cost Allocation Country Cultural Sensitivity Data Development Discipline Discrimination Doctor of Philosophy Educational Curriculum Educational Intervention Educational workshop Effectiveness Eligibility Determination Ensure Epidemic Evaluation Feedback Focus Groups Future Generations Goals Grant Guidelines HIV Health Personnel Healthcare High Prevalence Hospitals Human Rights Individual Institutes Intervention Interview Judgment Knowledge Learning Manuals Manuscripts Measurement Mentored Research Scientist Development Award Mentors Mentorship Needs Assessment New England Oral Pharmaceutical Preparations Phase Physicians Prejudice Preparation Prevalence Prevention Prevention strategy Preventive Intervention Primary Prevention Principal Investigator Provider Public Health Race Randomized Randomized Controlled Trials Research Research Activity Research Project Grants Resource Allocation Risk Scientist Statistical Data Interpretation Stereotyping Surveys Targeted Research Tenofovir Testing Time Training Training and Education United States United States Food and Drug Administration Universities Voice Washington Work Writing base black men who have sex with men career clinical decision-making clinical practice combat continuing medical education curriculum development design effective intervention emtricitabine evidence base experience health training high risk implicit bias informant innovation medical schools minority communities online resource post intervention pre-exposure prophylaxis prevent provider intervention psychologic public health relevance racial bias racism rehearsal skills social social disparities symposium therapy development truvada

项目摘要

DESCRIPTION (provided by applicant): Over thirty years into the United States epidemic, social disparities in HIV prevalence persist, with Black Americans, and Black men who have sex with men (MSM) in particular, disproportionately affected. Intensifying HIV prevention efforts in communities of high prevalence as well as maximizing the dissemination and impact of effective interventions are among the top national priorities for addressing HIV.1,2 The proposed training plan in this Mentored Research Scientist Development Award (K01) application will provide the essential knowledge and skills that the principal investigator, Sarah K. Calabrese, PhD, needs to launch a productive career in research targeting these public health imperatives. Further, the research conducted throughout the course of this award would contribute meaningfully to the successful delivery of pre-exposure prophylaxis (PrEP, i.e., oral antiretroviral medication for HIV prevention) in real-world clinical practice and could have far-reaching implications for equitable access across social lines. PrEP is a cutting-edge biomedical advancement that received United States Food and Drug Administration approval for prescription in July of 2012, sparking a push for its implementation in health care settings throughout the country. There has been mounting recognition of the need for provider training and education about PrEP3-7 and some discussion of cultural sensitivity being a component thereof,5 but minimal attention paid explicitly to the risk of disparate prescription practices. Documented discrimination in the prescription of antiretroviral medication for treatment purposes as well as preliminary evidence of biases in clinical judgment surrounding PrEP pose a call to action; the proposed research aims to address this call via the development and pilot testing of a single-session, group-based PrEP Awareness + Discrimination Prevention intervention for healthcare providers. The intervention will serve the dual purpose of increasing knowledge about PrEP among providers and averting discriminatory prescription practices using evidence-based strategies derived from social-cognitive psychology. The project will include a comprehensive needs assessment, including eight focus groups with potential PrEP providers from diverse clinical settings (n=48-64), six focus groups with Black MSM at risk for HIV acquisition (i.e., potential PrEP users; n=36-48), key informant interviews with healthcare providers who have experience prescribing PrEP (n=20), and a national quantitative survey of physicians (n=350). The intervention will be pilot tested in a two-armed randomized controlled trial with 80 healthcare providers seeking continuing medical education. The project will yield an intervention manual with detailed curriculum and supporting materials as well as preliminary indicators of intervention feasibility, acceptability, and effectiveness, setting the stage for future refinement and evaluation in the context of a larger-scale randomized controlled trial. The training acquired by Dr. Calabrese via this timely and innovative research project, in combination with formal coursework, focused workshops, academic conferences, manuscript preparation, grant-writing, one-on-one mentorship, and other research activities, will target the following three training objectives: (1) to gain mastery in the discipline of social-cognitive psychology on the topics of stereotyping, prejudice, and discrimination and to obtain training in measurement of implicit bias, (2) to gain expertise in intervention development, implementation, and evaluation, and (3) to enhance statistical analysis skills for application to planned research. Dr. Calabrese will be mentored primarily by John F. Dovidio, PhD, at Yale University, with additional mentoring from Nathan B. Hansen, PhD (Yale University), Kenneth H. Mayer, MD (Harvard Medical School/The Fenway Institute), Joseph R. Betancourt, MD, MPH (Harvard Medical School), and Manya Magnus, PhD, MPH (George Washington University). Dr. Calabrese's training through the proposed K01 award will round out her expertise and fully prepare her for a career as an independent research scientist in the field of HIV prevention.

描述（由申请人提供）：美国艾滋病毒流行已有三十多年了，艾滋病毒流行率的社会差异仍然存在，美国黑人，特别是男男性行为黑人 (MSM) 受到的影响尤其严重。在高流行社区加强艾滋病毒预防工作以及最大限度地扩大有效干预措施的传播和影响是解决艾滋病毒问题的国家首要优先事项之一。1,2 本指导研究科学家发展奖 (K01) 申请中拟议的培训计划将提供首席研究员 Sarah K. Calabrese 博士需要具备必要的知识和技能，才能在针对这些公共卫生问题的研究中开展富有成效的职业生涯。此外，在该奖项整个过程中进行的研究将对成功实施暴露前预防（PrEP，即针对艾滋病毒的口服抗逆转录病毒药物）做出有意义的贡献。预防）在现实世界的临床实践中，可能对跨社会领域的公平获取产生深远的影响。 PrEP 是一项尖端生物医学进展，于 2012 年 7 月获得美国食品和药物管理局处方批准，推动了其在全国医疗保健机构中的实施。人们越来越认识到需要对提供者进行有关 PrEP3-7 的培训和教育，并且对文化敏感性作为其中的一个组成部分进行了一些讨论5，但对不同处方做法的风险的明确关注很少。以治疗为目的的抗逆转录病毒药物处方中存在的歧视记录，以及围绕 PrEP 的临床判断存在偏差的初步证据，呼吁采取行动；拟议的研究旨在通过为医疗保健提供者开发和试点测试单次、基于小组的 PrEP 意识 + 歧视预防干预措施来解决这一问题。该干预措施将达到双重目的，即增加提供者对 PrEP 的了解，并使用源自社会认知心理学的循证策略避免歧视性处方做法。该项目将包括全面的需求评估，包括来自不同临床环境的潜在 PrEP 提供者的 8 个焦点小组 (n=48-64)、有感染 HIV 风险的黑人 MSM 的 6 个焦点小组（即潜在的 PrEP 用户；n=36） -48)、对有 PrEP 处方经验的医疗保健提供者的关键信息访谈 (n=20)，以及全国医生定量调查 (n=350)。该干预措施将在一项由 80 名寻求继续医学教育的医疗保健提供者参与的双臂随机对照试验中进行试点测试。该项目将产生一份干预手册，其中包含详细的课程和支持材料以及干预可行性、可接受性和有效性的初步指标，为未来在更大规模的随机对照试验中完善和评估奠定了基础。 Calabrese 博士通过这个及时且创新的研究项目获得的培训，结合正式课程、重点研讨会、学术会议、手稿准备、资助写作、一对一指导和其他研究活动，将针对以下目标：三个培训目标：(1) 掌握关于成见、偏见和歧视等主题的社会认知心理学学科，并获得内隐偏见测量方面的培训，(2) 获得干预措施制定、实施、和评估，(3) 增强统计分析技能，以应用于计划的研究。 Calabrese 博士将主要由耶鲁大学 John F. Dovidio 博士指导，另外还有 Nathan B. Hansen 博士（耶鲁大学）、Kenneth H. Mayer 医学博士（哈佛医学院/芬威学院）、 Joseph R. Betancourt，医学博士、公共卫生硕士（哈佛大学医学院）和Manya Magnus，博士、公共卫生硕士（乔治华盛顿大学）。 Calabrese 博士通过拟议的 K01 奖项接受的培训将完善她的专业知识，并为她作为艾滋病毒预防领域的独立研究科学家的职业生涯做好充分准备。