Training in implementation science research to improve PrEP services for people at risk for HIV

实施科学研究培训，以改善针对艾滋病毒高危人群的 PrEP 服务

• 批准号: 10532205
• 负责人: Sheri Ann Lippman
• 金额: $ 17.82万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10532205
• 关键词: AIDS prevention; Address; Area; Behavior Therapy; Brazil; Breathing; Caring; Clinic; Clinical; Collaborations; Communities; Community Health Aides; Community-Based Distributions; Competence; Complex; Consolidated Framework for Implementation Research; Country; Dedications; Disparity; Disparity population; Dose; Ensure; Environment; Epidemic; Equity; Evidence based intervention; Female Adolescents; HIV; HIV disparities; Health; Health Priorities; Health Services Accessibility; Health system; Human immunodeficiency virus test; Incidence; Individual; Infrastructure; Institution; Intervention; Leadership; Learning; Maintenance; Maps; Mentors; Methods; Monitor; Oral; Patients; Policies; Population; Population Group; Populations at Risk; Prevention; Process; Provider; Recommendation; Reproductive Health; Research; Research Personnel; Resources; Risk; Science; Scientific Inquiry; Scientist; Services; Sexual Health; Shapes; Site; South Africa; South African; State Interests; Structure; Taxonomy; Time; Training; Translating; Translations; United States National Institutes of Health; Work; acceptability and feasibility; barrier to care; care delivery; career; clinical practice; community living; community-level factor; experience; gender affirming care; health disparity populations; implementation context; implementation research; implementation science; implementation strategy; implementation study; improved; intervention delivery; member; men who have sex with men; mid-career faculty; next generation; patient oriented research; personalized approach; pre-exposure prophylaxis; prevent; primary care clinic; programs; rapid technique; research to practice; residence; routine practice; rural South Africa; rural health clinic; service delivery; skills; social; social structure; structural determinants; therapy development; tool; training opportunity; transgender women; uptake; working group; young woman

PROJECT SUMMARY/ABSTRACT Strategies for effective management of HIV care and prevention exist, however many evidence-based interventions, such as Pre-exposure prophylaxis (PrEP), are not sufficiently scaled into practice, failing to reach those most in need. Implementation science (IS) seeks to bridge the gap between research and practice to ensure that evidence-based interventions are translated effectively at scale. IS methods are rapidly evolving; trainees require mentors with dedicated time and research platforms to offer opportunities to learn and apply IS methods as they work towards independent research careers. In this proposal Dr. Sheri Lippman, Associate Professor in Residence at UCSF, proposes to: 1) expand her mentoring program, including formal training to attain mentoring competencies, to improve the breathe and depth of the training she offers early career scientists; 2) expand her own program of stakeholder-engaged IS research focused on means to improving PrEP delivery to populations who are underserved through addressing clinic- and health system-based barriers to care; and 3) provide early career scientists in UCSF programs and collaborating research institutions abroad with a platform to train in IS methods. Dr. Lippman has built a research portfolio focused on social-behavioral intervention development, supporting individuals and mobilizing communities to uptake HIV testing, prevention, and care, mostly in Brazil and South Africa. The patient-oriented research in this K24 includes exploring contextual domains from the Consolidated Framework for Implementation Research (CFIR) to characterize the PrEP delivery context in clinics attending transgender women (TGW) in São Paulo, Brazil, and clinics attending adolescent girls and young women (AGYW) in Agincourt, South Africa (Aim 1). The work then includes stakeholder engaged processes to arrive at a proposed set of implementation strategies to improve PrEP service delivery that facilitates PrEP uptake and maintenance based on the taxonomies from the Expert Recommendations for Implementing Change (ERIC) Project (Aim 2). Finally, strategies will be piloted at one clinic in each site to assess feasibility, acceptability, and monitoring processes to prepare for larger trials (R01s) that evaluate whether selected strategies improve PrEP delivery, uptake, and maintenance. The research focuses on PrEP delivery for TGW in Brazil and AGYW in South Africa as both are populations who have high HIV incidence, poor engagement in HIV care, and low uptake of PrEP despite stated interest in use. Dr. Lippman has extensive collaborations, including NIH-supported work, in both areas and can ensure abundant opportunities for mentoring and stimulating new research among early career investigators in the US and both countries. In sum, this K24 provides an opportunity for Dr. Lippman to expand her IS research to address barriers to PrEP delivery in the clinic and health-system environment through implementation strategies tailored to each site, concurrently building her mentoring program to ensure a pipeline of investigators with skills to establish new careers and scientific inquiry in the burgeoning field of IS.

项目概要/摘要 有效管理艾滋病毒护理和预防的策略是存在的，但有许多基于证据的策略 暴露前预防 (PrEP) 等干预措施尚未充分推广到实践中，未能达到 实施科学（IS）致力于弥合研究与实践之间的差距。 确保基于证据的干预措施得到有效大规模转化；信息系统方法正在迅速发展； 学员需要有专门时间和研究平台的导师来提供学习和应用信息系统的机会 在本提案中，谢里·利普曼 (Sheri Lippman) 博士是他们致力于独立研究事业的方法。 加州大学旧金山分校的常驻教授建议：1）扩大她的指导计划，包括正式培训 获得指导能力，以提高她提供的早期职业培训的呼吸和深度 2）扩大她自己的利益相关者参与的信息系统研究计划，重点关注改进方法 通过解决诊所和卫生系统的障碍，向服务不足的人群提供 PrEP 3) 为 UCSF 项目和国外合作研究机构提供早期职业科学家 Lippman 博士建立了一个专注于社会行为的研究组合。 制定干预措施，支持个人并动员社区进行艾滋病毒检测、预防、 K24 中以患者为导向的研究包括探索。 实施研究综合框架（CFIR）中的上下文领域来描述 巴西圣保罗变性女性 (TGW) 诊所的 PrEP 实施情况以及就诊的诊所 南非阿金库尔的少女和年轻妇女 (AGYW)（目标 1）。 利益相关者参与流程，以达成一套拟议的实施策略，以改进 PrEP 根据专家的分类法提供服务，促进 PrEP 的采用和维护 实施变革 (ERIC) 项目的建议（目标 2） 最后，将在其中试点战略。 每个地点的诊所评估可行性、可接受性和监测流程，为更大规模的试验做准备 (R01s) 评估所选策略是否改善 PrEP 的递送、吸收和维持。 研究重点是巴西 TGW 和南非 AGYW 的 PrEP 实施，因为这两个人群都是 艾滋病毒感染率高，艾滋病毒护理参与度低，尽管表示有兴趣使用 PrEP，但其使用率较低。 Lippman 博士在这两个领域都有广泛的合作，包括 NIH 支持的工作，并且可以确保 美国早期职业研究人员有大量指导和刺激新研究的机会 总之，K24 为 Lippman 博士提供了将她的 IS 研究扩展到以下领域的机会。 通过实施障碍解决在诊所和卫生系统环境中提供 PrEP 的问题 针对每个站点量身定制的策略，同时制定指导计划以确保渠道 具有在 IS 新兴领域建立新职业和科学探究技能的调查人员。