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

基本信息

批准号：
10327907
负责人：
JESSICA A SALES
金额：
$ 75.77万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
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/10327907
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 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&apos s Health Work base care delivery care seeking cis-female collaborative approach community engagement design evidence base 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

项目摘要

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.

抽象的供需限制影响了美国南部顺性别女性 PrEP 的扩大。暴露前预防使用需要确保可以从 PrEP 中受益的顺性别女性了解这一点（即需求方）并且确保顺性别女性寻求护理的环境（即供应方）可以获得 PrEP。锚定 PrEP 关心顺性别妇女已经信任、经常获得并认为由第十条资助的计划生育服务对她们的性健康有用的内容具有很大的吸引力，因为它提供了一个理想的机会来接触那些可能从 PrEP 中受益。在佐治亚州，艾滋病毒新诊断率最高的州，我们的工作表明许多 Title X 计划生育诊所不提供 PrEP。我们的研究还表明 PrEP 意识较低以及在亚特兰大顺性别女性中的使用。此外，我们位于亚特兰大的以计划生育为重点的 PrEP 实施研究表明，即使 FP 诊所提供 PrEP，也很少有顺性别女性接受 PrEP，和提供者指出，人们对 PrEP 的筛查、推荐和咨询持续感到不安。教训从 HPV 疫苗和避孕措施的推广中学到的经验表明，仅意识和可用性就可能不够；让顺性别女性从 PrEP 意识转向接受需要替代性分娩方式纳入妇女观点的模型，以克服阻碍妇女使用 PrEP 的其他因素。因此，提高顺性别女性的 PrEP 覆盖率可能需要更有效地让她们参与制定适当且可接受的以患者为中心的 PrEP 护理方法以支持采用。在拟议的项目，我们将（目标 1）使用交互式系统框架来采用定制实施我们之前开展的大量工作为战略提供了支持，以支持亚特兰大各地 PrEP 的采用和实施 Title 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顺性别女性对 PrEP 的认识、兴趣和联系的方法（满足需求）侧面障碍）；（目标 3）创新地使用以人为本的设计 (HCD)，一种以患者为中心的方法它将最终用户和开发商聚集在一起，共同制定护理服务战略，使南方将妇女的声音纳入 PrEP 护理服务战略的制定中。鉴于有关以下方面的研究有限增加南方顺性别女性的 PrEP 覆盖率的战略，每个目标的调查结果将独立填补了优化诊所和社区策略以加强艾滋病毒预防的众多空白对于南方女性来说。鉴于我们与佐治亚州计划生育系统（佐治亚州 Title X 受让人）的合作，亚特兰大地区 Title X 诊所，以及与性健康 CBO（由 SisterLove 领导）的牢固合作伙伴关系，我们具有独特的优势，可以在围绕我们诊所建立的亚特兰大各个县采取协调一致的方法- 学术界与 CBO 合作，加强对妇女的艾滋病毒预防，更重要的是，建立可持续的系统方法，将新的艾滋病毒预防（和性健康）创新更快地推广给女性。