Implementation and Dissemination of Evidence-Based Interventions to Improve PrEP Care Continuum Outcomes Among Women in Community Health Clinics in the Southern U.S.

实施和传播循证干预措施，以改善美国南部社区健康诊所妇女的 PrEP 护理连续性结果

• 批准号: 10472756
• 负责人: Amy Kristen Johnson
• 金额: $ 55.53万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10472756
• 关键词: AIDS prevention; Address; Adopted; Awareness; Black Populations; Black race; Clinic; Clinical; Community Health; Computerized Medical Record; Continuity of Patient Care; Dissemination and Implementation; Education; Eligibility Determination; Epidemic; Evidence based intervention; Exploration Preparation Implementation and Sustainment; HIV; HIV Infections; HIV diagnosis; HIV risk; High Risk Woman; Incidence; Individual; Intervention; Knowledge; Measures; Midwestern United States; Neighborhood Health Center; Outcome; Patients; Phase; Preparation; Prevention approach; Provider; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Research Methodology; Risk; Self Perception; Standardization; Training; United States; Woman; Work; black women; cis-female; design; effectiveness outcome; gender disparity; geographic disparity; health care settings; hybrid type 2 design; implementation framework; implementation measures; implementation outcomes; implementation research; implementation science; implementation strategy; improved; men; men who have sex with men; pre-exposure prophylaxis; primary care setting; racial disparity; research study; satisfaction; scale up; success; tool; transgender women; uptake

Significant disparities in pre-exposure prophylaxis (PrEP) for HIV prevention exist in the U.S. with cisgender women making up a disproportionately low percentage of PrEP users compared to men. 60% of new HIV diagnoses among women are among Black women, the majority of whom reside in the South. Challenges exist at each step of the PrEP care continuum, including difficulty identifying cisgender women at highest risk for HIV who are most likely to benefit from PrEP, low self-perception of HIV risk, low levels of PrEP knowledge, and barriers to PrEP initiation and persistence. While there has been growing knowledge of interventions to increase PrEP use among men who have sex with men and transgender women, much less is known about successful strategies to increase uptake and support PrEP persistence among Black cisgender women. Through preliminary work, our team has identified a set of successful strategies for PrEP Optimization among Women to Enhance Retention and Uptake (POWER Up) in community health center (CHC) settings, consisting of routine PrEP education for Black cisgender women, standardized provider training, electronic medical record tools for identifying women who would benefit from PrEP and tracking PrEP outcomes, and PrEP navigation. With These POWER Up strategies, a CHC network in the Midwest has more than doubled PrEP uptake among Black cisgender women and maintained PrEP persistence rates above the national average. These strategies have not been studied in CHCs with a large population of Black cisgender women outside of the Midwest. Therefore, we propose to refine, implement, and evaluate the impact of a CHC-focused intervention to improve PrEP care continuum outcomes for Black cisgender women in the Southern US, using implementation science research methods. Guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) implementation science framework, we will undertake the following aims: 1) Preparation: Adapt previously identified successful implementation strategies for engaging Black cisgender women in the PrEP care continuum in a Midwestern CHC for use in Southern CHCs. 2) Implementation: Via a hybrid type II design using the RE-AIM framework, measure the implementation and effectiveness outcomes of the adapted interventions in the Southern United States compared to the approach in the Midwest. We will complete a stepped wedge randomized controlled trial in 16 CHCs in the Midwest and South. 3) Sustainment and Spread: Develop an implementation guide that can be utilized across Southern U.S. jurisdictions to improve PrEP care continuum engagement among Black cisgender women reflecting the knowledge gained through adaptation. This will allow for rapid dissemination and replication of these strategies to improve PrEP care continuum outcomes among Black cisgender women.

美国的顺性别人群在预防艾滋病毒的暴露前预防 (PrEP) 方面存在显着差异 与男性相比，女性在 PrEP 用户中所占比例过低。 60% 新发艾滋病毒 女性中的诊断者是黑人女性，其中大多数居住在南方。挑战存在 PrEP 护理连续过程的每一步，包括难以识别感染艾滋病毒风险最高的顺性别女性 谁最有可能从 PrEP 中受益、对 HIV 风险的自我认知较低、PrEP 知识水平较低，以及 PrEP 启动和持续的障碍。尽管人们对干预措施的了解不断增加 增加男男性行为者和变性女性中 PrEP 的使用，但人们对此知之甚少 提高黑人顺性别女性的 PrEP 利用率并支持其坚持的成功策略。 通过前期工作，我们的团队确定了一套成功的 PrEP 优化策略 妇女在社区卫生中心 (CHC) 环境中增强保留和吸收 (POWER Up)， 包括针对黑人顺性别女性的常规 PrEP 教育、标准化提供者培训、电子 用于识别可从 PrEP 中受益的女性并跟踪 PrEP 结果的医疗记录工具，以及 PrEP 导航。通过这些 POWER Up 战略，中西部的 CHC 网络增加了一倍多 黑人顺性别女性的 PrEP 接受率和 PrEP 持续率高于全国水平 平均的。这些策略尚未在拥有大量黑人顺性别女性的社区卫生中心进行研究 中西部以外。因此，我们建议完善、实施和评估以 CHC 为重点的计划的影响 旨在改善美国南部黑人顺性别女性的 PrEP 护理连续性结果的干预措施，使用 实施科学研究方法。 以探索、准备、实施和维持 (EPIS) 实施科学为指导 框架中，我们将实现以下目标： 1) 准备：适应先前确定的成功的 中西部地区黑人顺性别女性参与 PrEP 护理连续体的实施策略 CHC 用于南方 CHC。 2) 实施：通过使用 RE-AIM 框架的混合 II 型设计， 衡量南部联合国家适应干预措施的实施和有效性结果 各州与中西部的做法进行了比较。我们将完成一个阶梯楔形随机控制 在中西部和南部的 16 个社区中心进行了试验。 3）维持和传播：制定实施指南 可以在美国南部司法管辖区使用，以改善 PrEP 护理的连续参与度 黑人顺性别女性反映了通过适应获得的知识。这将允许快速 传播和复制这些策略，以改善黑人中的 PrEP 护理连续性结果 顺性别女性。