PrEP 4 Her: Developing a Novel Strategy to Implement PrEP into Women's Healthcare

PrEP 4 Her：制定新策略将 PrEP 实施到女性医疗保健中

基本信息

批准号：
10682433
负责人：
Latesha Ellen Elopre
金额：
$ 25.72万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
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/10682433
关键词：
AIDS prevention Address Adoption Affect Age Alabama Appointment Area Awareness Behavior Therapy Belief Black race Caring Clinic Clinical Services Collaborations Communicable Diseases Communication Methods Communities Data Decision Making Diagnosis Disparity Effectiveness Epidemic Event FDA approved Family Planning Feedback Focus Groups Funding Gays Geographic Locations Geography Gynecologic Gynecologist Gynecology HIV HIV diagnosis HIV disparities HIV/AIDS Health Care Visit Healthcare Heterosexuals Improve Access Incidence Individual Inequity Interdisciplinary Study Interview Knowledge Link Low income Manuscripts Medical Methodology Methods Nurses Outcome Persons Pharmacists Pharmacy facility Phase Physicians Pilot Projects Prevention Prevention strategy Process Process Assessment Provider Psychology Reach, Effectiveness, Adoption, Implementation, and Maintenance Reproductive Health Research Research Design Research Personnel Risk Schedule Service delivery model Services Sexual Health Site Specialist Strategic Planning Surveys Techniques United States United States National Institutes of Health Universities Visit Vulnerable Populations Woman Women&apos s Health Work arm behavioral economics black women cis-female cisgender clinical care community engaged research community engagement epidemiologic data experimental study health care availability health inequalities implementation determinants implementation evaluation implementation measures implementation outcomes implementation science implementation strategy implementation study implementation trial improved informant innovation intervention mapping men who have sex with men novel strategies pre-exposure prophylaxis preference primary care provider primary health service programs racial minority population response routine care rural counties screening service delivery social stigma telehealth therapy development tool transmission process trend uptake

项目摘要

PROJECT SUMMARY HIV disproportionately affects Black cis-gender women, especially in the Southern United States (US). HIV pre- exposure prophylaxis (PrEP) was approved by the FDA in 2012 and is an effective prevention tool able to decrease HIV transmission up to 92% among cis-gender women. However, there has been minimal PrEP uptake among racial minority groups and inequitable utilization in the South. With implementation of behavioral interventions, primarily focused on demand creation (i.e. community distribution, scheduling PrEP appointments during events celebrating gay pride, etc.), PrEP utilization among almost all groups except Black cis-gender women has improved. Given these inequities, there is an urgent need to better understand how to improve PrEP utilization among Black cis-gender women in geographic locations with the greatest need, like the South. Black cis-gender women have significant individual-level barriers to PrEP utilization, including but not limited to low HIV/PrEP knowledge, PrEP stigma, and low perceived need. Programs to implement PrEP in Title X family planning clinics, where cis-gender women already receive routine care, provide attractive venues to improve access. However, in PrEP implementation studies at these clinic sites, while improvement in provider-knowledge and PrEP referrals occurred, PrEP uptake was still low when on-site services were not available. While more research is needed to improve PrEP access in family planning clinics that specialize in women’s healthcare, in states like Alabama, where clinics receiving Title X funding are currently not providing PrEP services, additional strategies are needed. Gynecology clinics offer an ideal setting for PrEP care as a part of routine reproductive and sexual health care. Gynecologists already provide primary health care services for many cis-gender women, oftentimes in place of a primary care provider, making this clinic setting ideal for integration of PrEP services tailored for Black women. Our implementation study is informed by compelling preliminary data from almost 800 Black cis-gender women living in Alabama using discrete choice experiment methodology, which determined their desired PrEP services would be delivered in a clinical care setting by a gynecologist, rather than telehealth or pharmacy based programs. The proposed study will pursue three specific aims: (1) Evaluate key determinants for implementation of PrEP into gynecology clinic settings through concurrent mixed-methods; (2) Develop and refine a multi-component implementation strategy to integrate PrEP in routine women’s health visits (i.e. PrEP4Her) and (3) Pilot PrEP4Her at a gynecology clinic. We will measure implementation outcomes grounded in the RE-AIM framework, incorporating constructs from Proctor et al, including: reach, efficacy, acceptability, fidelity, adoption and preliminary effectiveness. Upon completion of our proposed research, our inter-disciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research and psychology, will be primed to lead a multi-site type III implementation trial of PrEP service delivery at gynecology clinics across the South.

项目概要艾滋病毒对黑人顺性别女性的影响尤为严重，尤其是在美国南部。暴露预防（PrEP）于2012年获得FDA批准，是一种有效的预防工具，能够顺性别女性中的 HIV 传播率降低高达 92% 然而，PrEP 的采用率却很低。南方少数族裔群体的不平等利用和行为的实施。干预措施，主要侧重于创造需求（即社区分发、安排 PrEP 预约）在庆祝同性恋自豪感的活动期间等），除了黑人顺性别之外，几乎所有群体都使用了 PrEP 鉴于这些不平等，迫切需要更好地了解如何改善 PrEP。在最需要的地理位置（例如黑人），黑人顺性别女性的利用率。顺性别女性在使用 PrEP 方面存在显着的个人障碍，包括但不限于低 HIV/PrEP 知识、PrEP 耻辱以及在 Title X 家庭中实施 PrEP 的低认知需求。规划诊所已经为顺性别女性提供了常规护理，为改善现状提供了有吸引力的场所然而，在这些诊所开展的 PrEP 实施研究中，提供者的知识也有所提高。尽管发生了 PrEP 转诊，但在无法提供更多现场服务的情况下，PrEP 的采用率仍然较低。需要进行研究以改善专门从事妇女保健的计划生育诊所的 PrEP 获取情况，像阿拉巴马州这样的州，接受 Title X 资助的诊所目前不提供 PrEP 服务，另外妇科诊所需要为 PrEP 护理作为常规生殖的一部分提供理想的环境。和性保健服务，妇科医生已经为许多顺性别女性提供初级保健服务，通常代替初级保健提供者，使该诊所环境成为整合 PrEP 服务的理想选择我们的实施研究基于来自近 800 名黑人女性的令人信服的初步数据。居住在阿拉巴马州的黑人顺性别女性使用离散选择实验方法，确定了他们想要的 PrEP 服务将由妇科医生在临床护理环境中提供，而不是远程医疗拟议的研究将追求三个具体目标：（1）评估关键决定因素。通过并行混合方法在妇科诊所实施 PrEP； (2) 开发和实施完善多方面的实施策略，将 PrEP 纳入常规女性健康就诊（即 PrEP4Her）和（3）在妇科诊所试点 PrEP4Her 我们将衡量实施结果。在 RE-AIM 框架中，纳入了 Proctor 等人的构建，包括：范围、功效、可接受性、保真度、采用和初步有效性完成我们提出的研究后，我们的跨学科研究。团队，其中包括传染病、实施科学、社区参与研究和心理学，将准备领导妇科 PrEP 服务提供的多地点 III 型实施试验诊所遍布整个南方。