Improving HIV Prevention Services among Socioeconomically Disadvantaged Cis-gender Women

改善社会经济弱势顺性别女性的艾滋病毒预防服务

基本信息

批准号：
10677044
负责人：
Jenell S Coleman
金额：
$ 79.84万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-05 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10677044
关键词：
AIDS prevention Affect Assessment tool Baltimore Black race Caring Cities Clinic Clinical Clinical Trials Collaborations Communication Counseling Data Collection Disclosure Education Electronic Health Record Electronics Eligibility Determination Epidemic Equity Evidence based intervention Female Fumarates Funding Goals HIV HIV Infections HIV risk Health Benefit Health system Heterosexuals Human immunodeficiency virus test Hybrids Incidence Intervention Investments Knowledge Local Government Marketing Maryland Medicaid Methods Multimedia Office Visits Oral Patients Population Prenatal care Prevalence Provider Public Health Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recording of previous events Reporting Reproductive Health Services Risk Risk Assessment Risk Factors Self Administration Sexual Health Sexually Transmitted Diseases Site Surveys Technology Tenofovir Time United States United States Health Resources and Services Administration Woman animation arm black women budget impact care delivery cis-female clinical care computerized condoms consistent condom use contextual factors cost cost-effectiveness evaluation disadvantaged women disease transmission effective intervention effectiveness-implementation RCT emtricitabine high risk implementation strategy improved male medical specialties men men who have sex with men multi-component intervention patient population patient-level barriers pre-exposure prophylaxis preference prevention service primary outcome provider intervention provider-level barriers risk perception service delivery sex sexually active socioeconomic disadvantage standard of care tool uptake

项目摘要

ABSTRACT Nearly one out of five new HIV infections in the United States occurs among cisgender women, with 85% of cases attributed to heterosexual contact. Black women are disproportionately affected, comprising 60% of new HIV infections among women, although they comprise only 14% of the female population. Consistent condom use, daily oral tenofovir disoproxil fumarate 300mg-emtricitabine 200mg (TDF-FTC) as pre-exposure prophylaxis (PrEP), and male partner HIV testing are evidence-based interventions for women to reduce their risk of HIV acquisition. Yet, only 1-6% of women who could benefit from PrEP are prescribed it. Barriers to PrEP uptake are multifactorial. Patient-level barriers to PrEP uptake include women who may not think PrEP is for them, given that the majority of PrEP clinical trials and marketing strategies have targeted men who have sex with men. Also, cisgender women may not perceive themselves as being at risk for HIV. Further exacerbating the discordance between risk perception and actual risk is that women tend to be unaware of their male partners' HIV serostatus and HIV risk factors. Provider-level barriers include difficulty identifying patients at high risk for HIV, discomfort with sexual history taking, and lack of PrEP knowledge. Unfortunately, an accurate HIV risk assessment tool does not exist for U.S. cisgender women and may not ever exist because the HIV incidence in U.S. women is too low to develop it. An alternative evidence-based intervention is desperately needed. We plan to fill this gap by identifying an effective intervention and implementation strategy to increase PrEP uptake in an ObGyn clinical setting (where women receive prenatal care and sexual and reproductive health services). Since TDF-FTC was approved, women have consistently expressed a preference for receiving HIV prevention services in clinics where they receive ObGyn care. Our multi-level (patient and provider-level), multi-component intervention includes EHR data collection and education using multi-media tools. Our central hypothesis is that communicating tailored HIV risk messaging in real-time in a relatable and comprehensive manner to patients and ObGyn providers can increase conversations about HIV prevention. Aim 1A: To determine the most effective intervention and evaluate its implementation in an ObGyn clinical setting. 1B: To identify modifiable contextual factors associated with effective implementation using the RE-AIM framework. Aim 2: To evaluate the cost-effectiveness, return on investment, budget impact, and equity impact of the multi-level intervention components and the implementation strategy. In collaboration with our local government- and a HRSA-funded implementing partner sites, we hope to demonstrate a sustainable and scalable solution to increasing PrEP counseling by ObGyn providers and PrEP uptake by patients.

抽象的在美国，近五分之一的新艾滋病毒感染者是顺性别女性，其中 85% 归因于异性接触的病例。黑人女性受到的影响尤为严重，占新增人口的 60% 女性感染艾滋病毒，尽管她们仅占女性人口的 14%。一致的避孕套使用，每日口服富马酸替诺福韦二吡呋酯 300mg-恩曲他滨 200mg (TDF-FTC) 作为暴露前预防 (PrEP) 和男性伴侣艾滋病毒检测是女性降低艾滋病毒风险的循证干预措施获得。然而，只有 1-6% 可以从 PrEP 中受益的女性服用了该药。 PrEP 吸收的障碍是多因素的。患者层面采用 PrEP 的障碍包括可能认为 PrEP 不适合她们的女性，因为大多数 PrEP 临床试验和营销策略都是针对男男性行为者。还，顺性别女性可能不认为自己有感染艾滋病毒的风险。进一步加剧矛盾风险认知与实际风险之间的一个区别是，女性往往不知道其男性伴侣的艾滋病毒血清状况和艾滋病毒危险因素。提供者层面的障碍包括难以识别艾滋病毒高危患者、不适性病史采集和缺乏 PrEP 知识。不幸的是，准确的艾滋病毒风险评估工具对于美国顺性别女性来说不存在，并且可能永远不存在，因为美国女性的艾滋病毒发病率太低了，无法开发。迫切需要另一种基于证据的干预措施。我们计划填补这一空白通过确定有效的干预和实施策略来增加妇产科临床中 PrEP 的采用环境（妇女接受产前护理以及性健康和生殖健康服务的地方）。由于 TDF-FTC 是获得批准后，妇女一直表示愿意在诊所接受艾滋病毒预防服务他们在那里接受妇产科护理。我们的多层次（患者和提供者层面）、多成分干预包括使用多媒体工具进行 EHR 数据收集和教育。我们的中心假设是以相关且全面的方式向患者实时传达量身定制的艾滋病毒风险信息妇产科提供者可以增加有关艾滋病毒预防的对话。目标 1A：确定最有效的干预措施并评估其在妇产科临床环境中的实施情况。 1B：识别可修改的与使用 RE-AIM 框架有效实施相关的背景因素。目标 2：评估多层次干预的成本效益、投资回报、预算影响和公平影响组成部分和实施策略。与我们当地政府和 HRSA 资助的机构合作实施合作伙伴网站，我们希望展示一种可持续且可扩展的解决方案来增加 PrEP 妇产科提供者的咨询和患者对 PrEP 的采用。