Start the conversation: A multi-level PrEP initiative for Black women in NOLA

开始对话：针对诺拉黑人女性的多层次 PrEP 倡议

基本信息

批准号：
10403104
负责人：
Meredith Edwards Clement
金额：
$ 29.98万
依托单位：
DUKE 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：
2022-01-20 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10403104
关键词：
Address Administrative Supplement Adoption Advisory Committees Awareness Black race Caring Clinic Communities Educational Curriculum Epidemic Evaluation Feedback Focus Groups Funding Grant Gynecology HIV HIV Infections HIV diagnosis Health Health Services Accessibility Interview Link Location Louisiana Maintenance Measures Media Campaign Medical Methods Modeling Outcome Patients Provider Research Research Personnel Research Proposals Residencies Sexual Health Site Stress Testing Time Training Training Programs United States National Institutes of Health Universities Woman base black women care outcomes cis-female design effectiveness measure experience follow-up health disparity implementation evaluation implementation outcomes implementation research implementation science implementation strategy improved interest member pre-exposure prophylaxis programs shared decision making sharing platform social media social networking website uptake working group

项目摘要

PROJECT SUMMARY The rate of HIV diagnosis among Black cisgender women in Louisiana is almost 7 times higher than of White cisgender women. Multi-level implementation strategies are critically needed to reduce HIV infections among Black cisgender women in New Orleans, Louisiana (NOLA), an Ending the Epidemic priority jurisdiction. Using findings from our recently-conducted qualitative interviews with Black cisgender women and contributions from NOLA’s Black Women and PrEP Task Force, we have identified two main barriers that limit PrEP uptake among Black cisgender women in NOLA: (1) Black cisgender women do not know of other Black cisgender women taking PrEP, and (2) Black cisgender women are not offered PrEP during routine medical care. To address these determinants, we propose to develop and pilot a Start the Conversation Initiative that includes implementation strategies at the patient and provider levels. Aim 1 focuses on developing the patient-level implementation strategy, a social media campaign. Working with the Black Women and PrEP Task Force and a local community-based organization that specializes in social media campaigns, we will determine the content of the social media messages and the type of social media to use. We will conduct 4 focus group discussions with Black cisgender women to pre-test the social media content. Aim 2 focuses on developing the provider-level implementation strategies. We will develop a combined-care PrEP model that encourages GYN residents to (1) start a PrEP conversation with their patients and help them to determine if PrEP is right for them, and (2) help their patients to determine the best location of PrEP follow-up—either with the GYN residency clinic or with a routine PrEP provider. We will conduct 12 in-depth interviews (IDIs) with GYN and routine PrEP providers and establish a working group of GYN residents, GYN residency directors, and current PrEP providers to inform the combined-care PrEP model. In Aim 3, we will evaluate the implementation of the Start the Conversation Initiative. We will pilot the strategies at the Louisiana State University (LSU) GYN residency program over an 8-month period to inform acceptability, feasibility and potential impact. We will first implement the provider-level strategies, then layer in the patient-level strategies to examine impact on patient demand (PrEP uptake) and retention. The 8 months of combined implementation will be compared to PrEP uptake from a comparison GYN clinic at Tulane; one month retention in care outcomes will be measured at LSU. Implementation outcomes (adoption, fidelity, maintenance) will be assessed through chart review and triangulated with resident feedback sessions. We will also conduct 24 IDIs each with providers (n=12) and patients (n=12) to further inform acceptability, feasibility and appropriateness. At the end of the R34, we plan to submit a larger implementation research proposal with additional sites in the U.S. South to evaluate these optimized community-identified implementation strategies.

项目概要路易斯安那州黑人顺性别女性的艾滋病毒诊断率几乎是白人的 7 倍迫切需要采取多层次的实施战略来减少艾滋病毒感染。路易斯安那州新奥尔良 (NOLA) 的黑人顺性别女性，是结束流行病优先管辖区。我们最近对黑人顺性别女性进行的定性访谈的结果以及来自 NOLA 的黑人妇女和 PrEP 工作组，我们发现了限制 PrEP 吸收的两个主要障碍在诺拉的黑人顺性别女性中：(1) 黑人顺性别女性不知道其他黑人顺性别女性接受 PrEP 的女性，以及 (2) 在常规医疗护理期间不向黑人顺性别女性提供 PrEP。为了解决这些决定因素，我们建议制定并试点一项“开始对话倡议”，其中包括目标 1 侧重于发展患者层面实施战略、与黑人妇女和 PrEP 工作组合作的社交媒体活动以及一个专门从事社交媒体活动的当地社区组织，我们将确定我们将进行 4 次焦点小组讨论。与黑人顺性别女性进行讨论以预先测试社交媒体内容，目标 2 的重点是开发我们将开发一个鼓励 GYN 的联合护理 PrEP 模型。居民 (1) 与患者开始 PrEP 对话，帮助他们确定 PrEP 是否适合他们，以及 (2) 帮助患者确定 PrEP 随访的最佳地点——无论是在妇科医生那里住院医师诊所或常规 PrEP 提供者我们将与 GYN 和 GYN 进行 12 次深度访谈 (IDI)。常规 PrEP 提供者并建立一个由 GYN 住院医师、GYN 住院医师主任和现任住院医师组成的工作组 PrEP 提供者告知联合护理 PrEP 模型在目标 3 中，我们将评估 PrEP 的实施情况。我们将在路易斯安那州立大学 (LSU) GYN 试点该策略。我们将首先进行为期 8 个月的驻留计划，以告知其可接受性、可行性和潜在影响。实施提供者层面的策略，然后分层纳入患者层面的策略以检查对患者的影响需求（PrEP 的吸收）和保留率将与 PrEP 的 8 个月实施时间相结合进行比较。杜兰大学比较妇科诊所的吸收情况将在以下时间进行衡量：一个月的护理结果保留率路易斯安那州立大学将通过图表审查和评估实施结果（采用、保真度、维护）。我们还将与提供商进行 24 次 IDI（n=12）和患者 (n=12) 进一步告知可接受性、可行性和适当性在 R34 结束时，我们计划：提交一份更大的实施研究提案，其中包括美国南部的其他地点，以评估这些优化社区确定的策略实施。