PrEP Pro: Adapting a multi-component intervention to train and support providers to promote PrEP for adolescent girls and young women in the Deep South

PrEP Pro：采用多成分干预措施来培训和支持提供者，以促进南部腹地少女和年轻女性的 PrEP

• 批准号: 10663866
• 负责人: Latesha Ellen Elopre
• 金额: $ 22.28万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-13 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10663866
• 关键词: Acquired Immunodeficiency Syndrome; Administrator; Adolescent; Adult; African American; Alabama; Anti-Retroviral Agents; Attitude; Behavior; Behavioral Model; Black Populations; Black race; Caring; Client; Clinic; Collaborations; Communities; Consolidated Framework for Implementation Research; Data; Deep South; Education; Educational Curriculum; Educational process of instructing; Eligibility Determination; Enrollment; Epidemic; Epidemiology; Event; Evidence based intervention; Family Practice; Feedback; Female; Female Adolescents; Focus Groups; Funding; Future; Gender; HIV; HIV Infections; HIV-infected adolescents; HIV/STD; Health Knowledge Attitudes Practice; Health Personnel; Health Services Accessibility; Health Services Research; High Risk Woman; Hybrids; Incidence; Infection; Insurance; Intervention; Interview; Knowledge; Measures; Medical Education; Methods; Motivation; Oral; Outcome; Participant; Pattern; Persons; Pharmaceutical Preparations; Physicians; Policy Maker; Population; Positioning Attribute; Primary Care; Provider; Qualitative Methods; Recording of previous events; Research; Risk; Risk Reduction; Role; Rural; Science; Scientist; Screening procedure; Sexual Health; Sexual Transmission; Sexuality; Surveys; Techniques; Tenofovir; Testing; Training; Training Programs; United States National Institutes of Health; Woman; Work; acceptability and feasibility; adolescent health; behavior change; care providers; cis-female; cisgender; clinical care; community engaged research; effectiveness/implementation trial; evidence base; family support; formative assessment; implementation determinants; improved; intervention mapping; men; multi-component intervention; peer support; pilot test; pilot trial; post intervention; pre-exposure prophylaxis; primary outcome; provider behavior; provider intervention; research and development; risk perception; rural families; rural healthcare; screening; skills; social stigma; therapy development; tool; uptake; young woman

Narrative/Abstract Black adolescent girls and young women (AGYW) are at high-risk for HIV acquisition. Antiretroviral medication for pre-exposure prophylaxis (PrEP) is an effective, female-controlled strategy to dramatically reduce HIV-acquisition risk, but uptake is low. With funding from an Ending the HIV Epidemic (EtHE) supplement to the UAB Center for AIDS Research, we surveyed and interviewed health care providers working in Alabama. Our data suggest that providers do not consider prescribing PrEP to Black AGYW. Important barriers include client, provider, and community stigma around sexuality, challenges of obtaining a sexual history, limited training on PrEP indications and management, and structural limitations related to insurance. Using the Intervention Mapping, and the Capability-Opportunity-Motivation-Behavior model for behavioral change, we propose to adapt evidence-based curriculum on HIV epidemiology, PrEP indications and efficacy; skills building and client-facing tools for obtaining sexual histories; and provider PrEP Champions to create a multi-component context-specific provider intervention, PrEP-Pro. In Aim 1, we will adapt PrEP-Pro to Family Medicine trainees due to their role in caring for adolescents at stages of transition and substantial contributions to rural healthcare. We focus on residents in training to leverage trainee mindset and energy while seeding the Family Medicine workforce with PrEP informed providers. We will convene an advisory board of providers, PrEP Champions, AGYW, and clinic administrators to adapt existing content to the local context. We will solicit feedback on PrEP-Pro content from providers and AGYW through focus group discussions. In Aim 2, we will pre-test the adapted PrEP-Pro content with up to 12 Family Medicine residents and 2 PrEP Champions in rural and urban AL and further hone PrEP-Pro based on their feedback via surveys and in-depth interviews. We will then conduct an open pilot with 60 Family Medicine residents. Primary pilot outcomes are acceptability and feasibility. We will also measure PrEP knowledge and attitudes as well as PrEP prescribing patterns and HIV/STI testing in the 6-month periods pre- and post-intervention. In Aim 3 we will elucidate determinants to PrEP-Pro implementation by conducting in-depth interviews with providers, AGYW, and other key stakeholders, reviewing findings with our CAB, and seeking additional input through dissemination events to inform a future hybrid effectiveness/implementation trial. With expertise in adolescent health, sexual health, adult medical education, PrEP, qualitative methods, community-engaged research, and intervention development and a team led by women and African-American clinician-scientists who work, live, teach, and provide care in the Deep South, we are well-positioned to complete the proposed science, disseminate information to key stakeholders and policy makers, and apply these data to inform interventions to mitigate HIV for AGYW in the Deep South.

叙述/摘要 黑人少女和年轻女性 (AGYW) 感染艾滋病毒的风险很高。抗逆转录病毒 暴露前预防药物 (PrEP) 是一种有效的、由女性控制的策略，可显着 降低艾滋病毒感染风险，但吸收率较低。获得“结束艾滋病毒流行”项目 (EtHE) 的资助 作为 UAB 艾滋病研究中心的补充，我们调查并采访了正在工作的医疗保健提供者 在阿拉巴马州。我们的数据表明，医疗服务提供者不会考虑向 Black AGYW 开 PrEP。重要的 障碍包括客户、提供者和社区对性的耻辱、获得性服务的挑战 病史、PrEP 适应症和管理培训有限以及与保险相关的结构性限制。 使用干预映射和能力-机会-动机-行为模型 行为改变，我们建议调整有关 HIV 流行病学、PrEP 适应症的循证课程 和功效；用于获取性历史的技能培养和面向客户的工具；和 PrEP 冠军提供者 创建一个多组件的针对具体情况的提供者干预措施，PrEP-Pro。在目标 1 中，我们将采用 PrEP-Pro 家庭医学实习生，因为他们在照顾处于过渡阶段的青少年方面发挥着重要作用，并且具有重要意义 对农村医疗卫生事业的贡献。我们专注于培训中的住院医师，以充分利用学员的心态和精力 同时为家庭医学队伍培养 PrEP 知情提供者。我们将召集一个顾问委员会 提供者、PrEP 倡导者、AGYW 和诊所管理人员根据当地情况调整现有内容。 我们将通过焦点小组讨论向提供商和 AGYW 征求有关 PrEP-Pro 内容的反馈。在 目标 2，我们将与最多 12 名家庭医学住院医生和 2 名 PrEP 一起预先测试改编后的 PrEP-Pro 内容 农村和城市 AL 的倡导者，并根据调查和深入的反馈进一步完善 PrEP-Pro 采访。然后，我们将与 60 名家庭医学住院医师进行公开试点。主要试点成果是 可接受性和可行性。我们还将衡量 PrEP 知识和态度以及 PrEP 处方 干预前后 6 个月期间的模式和 HIV/STI 检测。在目标 3 中我们将阐明 通过与提供者、AGYW 和其他机构进行深入访谈，确定 PrEP-Pro 实施的决定因素 主要利益相关者，与我们的 CAB 一起审查调查结果，并通过传播活动寻求更多意见 为未来的混合有效性/实施试验提供信息。 拥有青少年健康、性健康、成人医学教育、PrEP、定性方法等方面的专业知识， 社区参与的研究、干预措施的制定以及由妇女和非裔美国人领导的团队 我们是在南方腹地工作、生活、教学和提供护理的临床医生科学家，我们有能力 完成拟议的科学，向主要利益相关者和政策制定者传播信息，并应用 这些数据可为南方腹地 AGYW 减轻艾滋病毒影响的干预措施提供信息。

项目成果

A Multicomponent Intervention to Train and Support Family Medicine Providers to Promote Pre-exposure Prophylaxis (PrEP) for Adolescent Girls and Young Women in the Deep South: Protocol for the PrEP-Pro Study.

• DOI: 10.2196/44908
• 发表时间: 2023-03-21
• 期刊: JMIR RESEARCH PROTOCOLS
• 影响因子: 1.7
• 作者: Isehunwa, Oluwaseyi;Hill, Samantha, V;Menninger, Alex Tobias;Hubner, Brook;Krakower, Douglas;Long, Dustin M.;Pratt, Madeline C.;Clement, Meredith E.;Van Wagoner, Nicholas;Lanzi, Robin Gaines;Simpson, Tina;Elopre, Latesha;Matthews, Lynn
• 通讯作者: Matthews, Lynn