PrEP Connect: Bridging HIV Testing to PrEP Screening and Uptake

PrEP 连接：将 HIV 检测与 PrEP 筛查和吸收联系起来

• 批准号: 10079952
• 负责人: Kathleen M MacQueen
• 金额: $ 19.7万
• 依托单位: FAMILY HEALTH INTERNATIONAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10079952
• 关键词: AIDS prevention; Agreement; Attention; Behavior; Caring; Characteristics; Cities; Client; Clinical Trials Design; Code; Communities; Counseling; County; Data; Data Analyses; Data Collection; Deception; Development; Discrimination; Economics; Educational Intervention; Effectiveness of Interventions; Elements; Environment; Epidemic; Equilibrium; Evaluation; Event; Exercise; Frequencies; Funding; Goals; HIV; HIV/STD; Health; Healthcare; High Risk Woman; Human immunodeficiency virus test; Insurance; Intake; Intervention; Interview; Mediation; Medical; Methods; Minority Access; North Carolina; Patients; Population; Prevention; Procedures; Process; Provider; Reporting; Research; Resources; Role; Service provision; Services; Sexual Health; Sexual and Gender Minorities; Structure; Surveys; Techniques; Testing; Time; Training; Visualization; Walking; base; data collection site; effectiveness evaluation; empowerment; experience; health care availability; high risk; improved; innovation; interest; men; men who have sex with men; pre-exposure prophylaxis; prevention service; racial discrimination; recruit; research clinical testing; screening; service delivery; social stigma; standard of care; transgender women; transmission process; uptake

PROJECT SUMMARY This proposal responds to PA-19-050 Engaging Men in HIV Testing, Prevention, and Care and to NOT-MD-19- 001 Notice of Special Interest in Research on the Health of Sexual and Gender Minority (SGM) Populations. HIV testing is an essential first step in reducing HIV transmission rates, but the prevention counseling component has been significantly reduced in recent years and has not incorporated validated PrEP referral processes as standard of care. For those most in need of prevention services additional barriers include the cumulative impact of experiences of racial discrimination and social stigma against SGMs compounded with persistent HIV stigma. The impact of these forces on HIV testing and prevention are widely acknowledged but remain extremely difficult to intervene upon. This exploratory study combines an innovative participatory approach and intersectional stigma framework to understand how black SGM in a Southern city experience HIV/STI testing and PrEP referral. We build on existing simulated client/patient approaches to elicit, observe, and interpret interactional behaviors in health settings to capture black SGM experiences in close to real time and proximity to the environments where they receive testing and PrEP services. The goal is to understand the subjective experience of the simulated client/patient, not conduct an objective evaluation of the provider. In Aim 1 we will (a) recruit and train eight black SGM to perform in the role of a simulated client/patient accessing HIV/STI testing and PrEP services and (b) conduct simulated walk-through exercises with providers to document and describe their standard mode of service delivery and negotiate agreements for how simulated clients/patients will access their services. In Aim 2 simulated clients/patients will complete structured surveys immediately before and after each engagement with a provider (n=32 events) followed by a qualitative de-brief interview. We will then conduct in-depth interviews with providers to understand their perspectives on the types of experiences reported. Qualitative coding and structured survey data will be combined using a matrix-based applied thematic analysis approach, including use of frequency tables and visualization techniques to compare and contrast black SGM intersectional experiences of stigma, discrimination, empowerment, and confirmation. Aim 3 centers on participatory intervention mapping with stakeholders including black SGM and providers to review the range of prevention experiences and collaboratively identify ways to improve (a) the referral/intake experience, (b) the capacity of providers to identify clients likely to benefit from PrEP, and (c) linkage to and uptake of PrEP by clients at highest risk. Findings will be of immediate value for local quality improvement in services, inform the expansion of HIV prevention services more broadly in North Carolina, and inform development of an equity-based provider training intervention to reduce experiences of intersectional stigma for black SGM accessing HIV prevention services.

项目摘要 该建议对PA-19-050参与艾滋病毒测试，预防和护理的参与者做出了回应，而不是MD-19-- 001关于性别和性别少数民族（SGM）人口健康研究的特别兴趣通知。 艾滋病毒测试是降低艾滋病毒传播率的重要第一步，但预防咨询 近年来，组件已大大减少，尚未纳入经过验证的PREP推荐 过程作为护理标准。对于大多数需要预防服务的人，其他障碍包括 种族歧视和社会污名对SGM的累积影响 持续的艾滋病毒污名。这些力量对艾滋病毒测试和预防的影响得到了广泛的认可，但 仍然很难干预。这项探索性研究结合了创新的参与性 接近和交叉污名框架，以了解南部城市的黑人SGM如何体验 HIV/STI测试和PREP推荐。我们以现有的模拟客户/患者方法来启动，观察， 并解释健康环境中的互动行为，以捕获实时的黑人SGM体验 以及靠近他们获得测试和准备服务的环境。目标是了解 模拟客户/患者的主观经验，而不是对提供商进行客观评估。目标 1我们将（a）招募和培训八个黑色SGM以执行模拟客户/患者访问的角色 HIV/STI测试和准备服务以及（b）与提供者进行模拟的演练练习 记录并描述他们的标准服务交付方式，并就模拟方式进行谈判协议 客户/患者将获得服务。在AIM 2中，模拟客户/患者将完成结构化调查 在每次与提供商的参与之前和之后紧接（n = 32个事件），然后进行定性脱口秀 面试。然后，我们将对提供者进行深入的访谈，以了解他们对类型的观点 报告的经验。定性编码和结构化调查数据将使用基于矩阵的 应用主题分析方法，包括使用频率表和可视化技术来比较 以及对比污名，歧视，授权和确认的黑色SGM SGM交叉经历。 目的是与包括黑人SGM和提供商在内的利益相关者参与性干预映射的3个中心 审查预防经验的范围，并协作确定改善（a）推荐/摄入量的方法 经验，（b）提供者确定可能从准备中受益的客户的能力，以及（c）与和 客户对处于最高风险的准备。调查结果对于当地质量改善将是直接价值的 服务，在北卡罗来纳州更广泛地告知艾滋病毒预防服务的扩张，并告知 开发基于股票的提供者培训干预措施，以减少交叉污名的经验 用于访问HIV预防服务的黑人SGM。