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: 10676120
• 负责人: Amy Kristen Johnson
• 金额: $ 54.8万
• 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/10676120
• 关键词: AIDS prevention; Address; Adopted; Awareness; Black Populations; Black race; Clinic; Clinical; Community Health; Continuity of Patient Care; Disparity; 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; Inequity; 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; electronic medical record tool; 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; 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.

在美国，预防艾滋病毒预防的预防前预防差异很大 与男性相比，妇女的预备使用者比例少了。新艾滋病毒的60％ 妇女中的诊断是黑人妇女，其中大多数居住在南方。存在挑战 在预备护理连续体的每个步骤中 谁最有可能受益于准备，对艾滋病毒风险的低自我认知，低水平的准备知识以及 准备启动和持久性的障碍。尽管对干预措施的了解越来越多 增加与男人和变性女性发生性关系的男性的准备使用者，对 成功地增加了黑人妇女妇女的吸收和支持持久性的策略。 通过初步工作，我们的团队确定了一系列成功的策略以进行准备 妇女在社区卫生中心（CHC）环境中增强保留和吸收（加电）， 由黑色顺性妇女的常规预备教育，标准化提供商培训，电子 病历工具，用于识别将从准备和跟踪准备成果中受益的女性，并且 准备导航。有了这些电力策略，中西部的CHC网络增加了一倍以上 黑色顺性妇女的预先吸收，并维持以上的持久性持续性率 平均的。这些策略尚未在CHC中研究，其中大量黑色scisger妇女 在中西部。因此，我们建议精炼，实施和评估以CHC为中心的影响 干预措施以改善美国南部黑色顺性妇女的预科护理连续性结果， 实施科学研究方法。 在探索，准备，实施和维持（ESIP）实施科学的指导下 框架，我们将承担以下目的：1）准备：适应先前确定的成功 实施策略，使黑色的cisgender妇女参与中西部的预科护理连续体 CHC用于南部卫生室。 2）实现：通过使用Re-Aim框架的混合II类型设计， 衡量南部联合的改编干预措施的实施和有效性 与中西部的方法相比。我们将完成一个阶梯楔随机控制 在中西部和南部的16个CHC中进行试验。 3）维持和传播：制定实施指南 可以在美国南部司法管辖区中使用，以改善预备护理连续体的参与 黑色的妇女反映了通过适应获得的知识。这将允许快速 这些策略的传播和复制，以改善黑人的准备连续性结果 赋予妇女。

项目成果

POWER Up-Improving pre-exposure prophylaxis (PrEP) uptake among Black cisgender women in the Southern United States: Protocol for a stepped-wedge cluster randomized trial (SW-CRT).

• DOI: 10.1371/journal.pone.0285858
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Ridgway, Jessica P. P.;Devlin, Samantha A. A.;Friedman, Eleanor E. E.;Enaholo, Ososese E. E.;Pyra, Maria;Hirschhorn, Lisa R. R.;Haider, Sadia;Ducheny, Kelly;Johnson, Amy K. K.
• 通讯作者: Johnson, Amy K. K.