Accelerating Equitable PrEP Delivery for Black Adults in Primary Care Settings: Development and Testing of A Practice-Level Multifaceted Implementation Strategy

加快初级保健机构中黑人成人的公平 PrEP 实施：制定和测试实践层面的多方面实施策略

• 批准号: 10761903
• 负责人: Dovie Watson
• 金额: $ 19.49万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-16 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10761903
• 关键词: AIDS prevention; Acceleration; Address; Administrator; Adult; Award; Black Populations; Black race; Board Certification; Caring; Client; Collaborations; Communicable Diseases; Communities; Consolidated Framework for Implementation Research; Continuity of Patient Care; Development; Environment; Epidemic; Equity; Evaluation; Evidence based practice; Foundations; Funding; Gender; Goals; HIV; Heterosexuals; Incidence; Individual; Inequity; Interview; Investments; K-Series Research Career Programs; Knowledge; Leadership; Lesbian Gay Bisexual Transgender Queer; Maps; Measures; Medical; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Modality; National Institute of Mental Health; National Institute on Minority Health and Health Disparities; Outcome; Patients; Philadelphia; Physicians; Population; Positioning Attribute; Preventive service; Provider; Public Health; Qualitative Research; Research; Research Design; Research Methodology; Research Personnel; Research Priority; Resources; Scientist; Sex Orientation; Sexism; Sexual Health; Sexuality; Social Environment; Social Sciences; Surveys; Testing; Training; United States; Work; acceptability and feasibility; arm; behavior change; behavioral and social science; black patient; care outcomes; career; cisgender; community engaged research; design; effectiveness/implementation trial; evidence base; experimental arm; gender diversity; implementation design; implementation determinants; implementation evaluation; implementation science; implementation strategy; improved; innovation; interdisciplinary approach; multidisciplinary; next generation; novel; pilot trial; pleasure; pre-exposure prophylaxis; primary care patient; primary care practice; primary care services; primary care setting; provider behavior; racism; social cognitive theory; social science research; social stigma; theories; trial design

PROJECT SUMMARY/ABSTRACT Substantial measures must be taken in the United States to rectify the marked inequities in HIV pre-exposure prophylaxis (PrEP) outcomes among Black adults. PrEP implementation among Black populations is undermined by individual, interpersonal, and structural barriers rooted in stigma, racism, heterosexism, and sexism. Improving PrEP provision has become imperative as novel modalities emerge. There is an urgent need to develop implementation strategies that accelerate equitable PrEP delivery. The goal of this K23 is to facilitate Dr. Watson’s long-term goal to become an independent investigator focused on the development of implementation strategies to achieve equitable HIV prevention outcomes among Black populations. The proposed K23 will focus on designing and testing a multifaceted implementation strategy to support PrEP provision for Black primary care patients, grounded in an adapted conceptual framework that includes constructs from the Consolidated Framework for Implementation Research (CFIR) and Bandura’s Social Cognitive Theory. Dr. Watson’s proposed research plan will consist of training objectives in (1) qualitative research, (2) behavioral and social science research (BSSR), (3) community-engaged research, and (4) implementation science. With a focus on equity-centered applications within implementation science and community-engaged research, she requires further training in qualitative research, BSSR, and trial design to develop and pilot an implementation strategy to increase local PrEP provision capacity. These training objectives will be achieved through mentorship from an exemplary multidisciplinary mentorship team, complementary research aims, professional development activities, and coursework. Specifically, she plans to: (Aim 1) Identify key provider-, practice-, and community-level CFIR- based determinants of local PrEP delivery; (Aim 2) Develop a theory-informed multifaceted implementation strategy that follows a destigmatizing sexual health framework to accelerate equitable PrEP delivery for adult Black primary care patients; (Aim 3) Conduct a 12-month two-arm pilot trial to evaluate implementation strategy feasibility and acceptability at four medical practices that provide primary care services. The results of this study will be important for the field of implementation science as it focuses on facilitating theory- informed behavior changes among providers and practice leadership to accelerate equitable PrEP provision for Black primary care patients. Findings from the pilot will inform the design and submission of an R01 application for a hybrid effectiveness-implementation trial of the implementation strategy in year 4. The proposal will form a strong foundation for Dr. Watson’s continued development toward an independently funded research career as an implementation scientist invested in the development of implementation strategies to achieve equitable HIV prevention care outcomes among Black adults in the U.S.

项目概要/摘要 美国必须采取实质性措施纠正艾滋病毒暴露前的明显不平等现象 黑人成年人中预防 (PrEP) 的结果是黑人人群中 PrEP 的实施情况。 因个人、人际和结构性障碍而受到损害，这些障碍植根于耻辱、种族主义、异性恋主义和 随着新模式的出现，改善 PrEP 的提供已刻不容缓。 需要实施加速公平 PrEP 实施的战略 本 K23 的目标是。 促进沃森博士的长期目标，成为一名专注于 制定实施战略，以在黑人中实现公平的艾滋病毒预防成果 拟议的 K23 将侧重于设计和测试多方面的实施策略。 以适应的概念框架为基础，支持为黑人初级保健患者提供 PrEP 其中包括实施研究综合框架 (CFIR) 的构建以及 班杜拉的社会认知理论。沃森博士提出的研究计划将包括培训目标。 (1) 定性研究，(2) 行为和社会科学研究 (BSSR)，(3) 社区参与 研究，(4) 实施科学，重点关注以公平为中心的应用。 实施科学和社区参与的研究，她需要进一步的定性培训 研究、BSSR 和试验设计，以制定和试点实施策略以增加当地 PrEP 这些培训目标将通过模范的指导来实现。 多学科导师团队、互补的研究目标、专业发展活动，以及 具体来说，她计划：（目标 1）确定关键提供者、实践和社区级别的 CFIR- （目标 2）开发基于理论的多方面实施 遵循去污名化性健康框架的战略，以加速公平的 PrEP 实施 成年黑人初级保健患者；（目标 3）进行为期 12 个月的双臂试点试验以评估实施情况 提供初级保健服务的四种医疗机构的战略可行性和可接受性。 这项研究对于实施科学领域非常重要，因为它的重点是促进理论- 提供者和实践领导者之间的知情行为改变，以加速公平的 PrEP 提供 针对黑人初级保健患者的试点结果将为 R01 的设计和提交提供信息。 申请在第四年对实施战略进行混合有效性-实施试验。 该提案将为沃森博士继续向独立的方向发展奠定坚实的基础 作为一名科学家资助研究生涯实施投资于实施的发展 在美国黑人成年人中实现公平的艾滋病毒预防护理结果的策略