The design and evaluation of strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings

设计和评估在社区药房环境中对孕妇实施艾滋病毒预防干预措施的策略

• 批准号: 10322761
• 负责人: Melissa Mugambi
• 金额: $ 14.31万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10322761
• 关键词: AIDS prevention; Administrator; Age; Caring; Catchment Area; Clinic; Communities; Community Pharmacy; Complement; Consensus; Data; Development; Environment; Evaluation; Face; First Pregnancy Trimester; Foundations; Future; Goals; HIV; HIV Infections; Health; Health Services; Healthcare; Healthcare Systems; Hearing; Improve Access; Intervention; Interview; K-Series Research Career Programs; Kenya; Lead; Mentors; Methods; Modeling; Oral; Patients; Pharmacy facility; Play; Pregnancy; Pregnancy Tests; Pregnant Women; Prevalence; Provider; Reporting; Reproductive Health Services; Research; Research Personnel; Resources; Risk; Role; Scientist; Solid; Structure; Subgroup; Surveys; System; Testing; Theoretical Domains framework; Time; Training; Universities; Vertical Disease Transmission; Visit; Washington; Woman; Work; World Health Organization; antenatal care; base; behavior change wheel; care systems; career; chronic infection; cost; cost efficient; cost estimate; design; experimental study; implementation cost; implementation intervention; implementation science; implementation strategy; improved; intervention cost; intervention delivery; model design; novel; pilot test; pre-exposure prophylaxis; preference; prevention service; preventive intervention; programs; ranpirnase; reproductive; screening; service providers; theories; uptake

PROJECT SUMMARY: Pregnant women in high HIV-burden settings such as western Kenya are at increased risk of acquiring HIV infection during pregnancy. The World Health Organization (WHO) and Ministry of Health in Kenya recommend a comprehensive HIV prevention package for pregnant women in high HIV-burden settings including oral pre-exposure prophylaxis (PrEP), STI screening and treatment, and partner testing. However, poor utilization of antenatal care limits opportunities for timely identification and delivery of HIV prevention interventions. In Kenya, community pharmacies are often the first point of contact for basic health services and an important entryway for reproductive health services. Leveraging existing structures, such as community pharmacies, can create cost-efficient opportunities for improving access to HIV prevention interventions among pregnant women. However, it is unclear which combination of interventions would best satisfy pregnant women’s needs and optimize uptake, which strategies should be used for implementation, and the cost of extending implementation of these interventions to community pharmacy settings. The overall objective of this study is to design and evaluate strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings. In Aim 1, we propose to conduct a discrete choice experiment to quantify preferences for delivery of HIV prevention interventions (including PrEP, STI screening and treatment, and partner testing) for pregnant women in community pharmacy settings. Latent class analysis will be used to quantify women’s stated preferences and identify packages of intervention components that optimize uptake among different subgroups of women. In Aim 2, we will identify provider- and system-level factors that might influence implementation of the optimal intervention packages and select strategies to improve implementation. Finally, in Aim 3, we will evaluate the potential costs of extending implementation of HIV prevention interventions from the clinic to community pharmacy settings under a range of different intervention packages (Aim 1) and implementation strategies (Aim 2). The proposed research aims complement my training goals in (1) community-based model design for HIV prevention intervention delivery, (2) stated-preference theory and methods and the application of discrete-choice experiments, (3) implementation science, and, in particular, implementation strategy design, and (4) advanced costing methods and their application to costing implementation strategies. Successful completion of these aims will enable me, as part of a future R01, to pilot test and assess the acceptability, feasibility, and impact of a pharmacy-based model for delivering HIV prevention interventions to pregnant women. My long-term goal is to become an independent implementation scientist and design new models of care to implement and scale HIV prevention interventions for pregnant women. Alongside outstanding expertise from an interdisciplinary mentoring team and the excellent training and research environment at The University of Washington, this career development award provides a solid foundation for me to launch my career as an independent researcher.

项目摘要：在肯尼亚西部等艾滋病毒高负担地区，孕妇的感染率有所增加 世界卫生组织 (WHO) 和卫生部指出，怀孕期间感染艾滋病毒的风险。 肯尼亚建议为艾滋病毒高负担地区的孕妇提供全面的艾滋病毒预防方案 包括口服暴露前预防 (PrEP)、STI 筛查和治疗以及伴侣检测，但效果不佳。 产前保健的利用限制了及时识别和提供艾滋病毒预防的机会 在肯尼亚，社区药房往往是基本卫生服务和干预措施的第一接触点。 利用现有结构（例如社区）的重要入口。 药房可以创造具有成本效益的机会，以改善人们获得艾滋病毒预防干预措施的机会 然而，尚不清楚哪种干预措施组合最能满足孕妇的需求。 需求和优化采用，应使用哪些策略来实施，以及扩展的成本 本研究的总体目标是对社区药房环境实施这些干预措施。 设计和评估对社区孕妇实施艾滋病毒预防干预措施的策略 在目标 1 中，我们建议进行离散选择实验来量化偏好。 提供艾滋病毒预防干预措施（包括 PrEP、性传播感染筛查和治疗以及伴侣检测） 社区药房环境中的孕妇将使用潜在类别分析来量化妇女的陈述。 偏好并确定可优化不同亚组之间吸收的干预措施组合 在目标 2 中，我们将确定可能影响实施的提供者和系统层面的因素。 最后，在目标 3 中，我们将评估最佳干预方案和选择策略。 将艾滋病毒预防干预措施从诊所扩大到社区的潜在成本 一系列不同干预措施（目标 1）下的药房环境和实施策略（目标 2). 拟议的研究目标补充了我在 (1) 基于社区的艾滋病毒模型设计方面的培训目标。 预防干预实施，（2）陈述偏好理论与方法以及离散选择的应用 实验，（3）科学实施，特别是实施策略设计，以及（4）先进 成本计算方法及其在成本计算实施策略中的应用成功完成这些目标。 将使我能够作为未来 R01 的一部分，进行试点测试并评估某个项目的可接受性、可行性和影响 基于药房的模式为孕妇提供艾滋病毒预防干预措施 我的长期目标是 成为一名独立于实施的科学家，设计新的护理模式来实施和扩展艾滋病毒 以及针对孕妇的预防干预措施。 华盛顿大学的导师团队以及优良的培训和研究环境，让这个职业 发展奖为我作为独立研究员开展职业生涯提供了坚实的基础。