The design and evaluation of strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings

项目概要：在肯尼亚西部等艾滋病毒高负担地区， 怀孕期间感染艾滋病毒的风险。世界卫生组织（世卫组织）和卫生部 在肯尼亚，建议为艾滋病毒高负担地区孕妇提供一套全面的艾滋病毒预防措施 包括口服暴露前预防（PrEP）、性传播感染筛查和治疗以及伴侣检测。然而，穷 产前保健的利用限制了及时识别和提供艾滋病毒预防的机会 干预措施。在肯尼亚，社区药房往往是基本保健服务的第一接触点， 生殖健康服务的重要入口。利用现有结构，如社区 药店，可以创造具有成本效益的机会，改善艾滋病毒预防干预措施的获得， 孕妇然而，目前还不清楚哪种干预措施的组合最能满足孕妇的需求。 需要和优化吸收，应使用哪些战略来执行，以及推广的成本 在社区药房实施这些干预措施。本研究的总体目标是 设计和评估在社区实施孕妇艾滋病毒预防干预措施的战略 药房设置。在目标1中，我们建议进行一个离散选择实验，以量化对 提供艾滋病毒预防干预措施（包括PrEP、性传播感染筛查和治疗以及伴侣检测）， 社区药房的孕妇。潜在类别分析将被用来量化妇女的陈述 优先选择，并确定一揽子干预措施，优化不同亚组的吸收 对妇女在目标2中，我们将确定可能影响 最佳的干预措施和选择战略，以改善执行情况。最后，在目标3中，我们将评估 将艾滋病毒预防干预措施的实施从诊所扩大到社区的潜在成本 根据一系列不同的干预方案（目标1）和实施策略（目标 2）。拟议的研究目标补充了我的培训目标：（1）基于社区的艾滋病毒模型设计 预防干预的实施;（2）状态偏好理论与方法及离散选择的应用 实验，（3）实施科学，特别是实施战略设计，（4）先进的 成本计算方法及其在成本计算实施战略中的应用。圆满完成这些目标 作为未来R 01的一部分，将使我能够进行试点测试和评估可接受性，可行性和影响， 为孕妇提供艾滋病毒预防干预措施的基于药物的模式。我的长期目标是 成为一名独立的实施科学家，设计新的护理模式，以实施和扩大艾滋病毒 对孕妇的预防干预。除了来自跨学科的杰出专业知识， 导师团队和优秀的培训和研究环境在华盛顿大学，这个职业生涯 发展奖为我作为一名独立研究员的职业生涯奠定了坚实的基础。

PROJECT SUMMARY: Pregnant women in high HIV-burden settings such as western Kenya are at increased risk of acquiring HIV infection during pregnancy. The World Health Organization (WHO) and Ministry of Health in Kenya recommend a comprehensive HIV prevention package for pregnant women in high HIV-burden settings including oral pre-exposure prophylaxis (PrEP), STI screening and treatment, and partner testing. However, poor utilization of antenatal care limits opportunities for timely identification and delivery of HIV prevention interventions. In Kenya, community pharmacies are often the first point of contact for basic health services and an important entryway for reproductive health services. Leveraging existing structures, such as community pharmacies, can create cost-efficient opportunities for improving access to HIV prevention interventions among pregnant women. However, it is unclear which combination of interventions would best satisfy pregnant women’s needs and optimize uptake, which strategies should be used for implementation, and the cost of extending implementation of these interventions to community pharmacy settings. The overall objective of this study is to design and evaluate strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings. In Aim 1, we propose to conduct a discrete choice experiment to quantify preferences for delivery of HIV prevention interventions (including PrEP, STI screening and treatment, and partner testing) for pregnant women in community pharmacy settings. Latent class analysis will be used to quantify women’s stated preferences and identify packages of intervention components that optimize uptake among different subgroups of women. In Aim 2, we will identify provider- and system-level factors that might influence implementation of the optimal intervention packages and select strategies to improve implementation. Finally, in Aim 3, we will evaluate the potential costs of extending implementation of HIV prevention interventions from the clinic to community pharmacy settings under a range of different intervention packages (Aim 1) and implementation strategies (Aim 2). The proposed research aims complement my training goals in (1) community-based model design for HIV prevention intervention delivery, (2) stated-preference theory and methods and the application of discrete-choice experiments, (3) implementation science, and, in particular, implementation strategy design, and (4) advanced costing methods and their application to costing implementation strategies. Successful completion of these aims will enable me, as part of a future R01, to pilot test and assess the acceptability, feasibility, and impact of a pharmacy-based model for delivering HIV prevention interventions to pregnant women. My long-term goal is to become an independent implementation scientist and design new models of care to implement and scale HIV prevention interventions for pregnant women. Alongside outstanding expertise from an interdisciplinary mentoring team and the excellent training and research environment at The University of Washington, this career development award provides a solid foundation for me to launch my career as an independent researcher.