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

项目摘要：肯尼亚西部等艾滋病毒负担高的地区的孕妇人数增加 在怀孕期间感染艾滋病毒的风险。世界卫生组织(WHO)和卫生部 在肯尼亚，建议为艾滋病毒负担高的孕妇提供全面的艾滋病毒预防一揽子计划 包括口服暴露前预防(PrEP)、性传播感染筛查和治疗以及伴侣测试。然而，贫穷 产前护理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个联系点。 生殖健康服务的重要入口。利用现有结构，如社区 药房，可以创造具有成本效益的机会，以改善获得艾滋病毒预防干预措施的机会 怀孕的女人。然而，目前还不清楚哪种干预措施组合最能满足孕妇的 需求和优化吸收、应使用哪些战略来实施以及扩展的成本 将这些干预措施落实到社区药房环境中。这项研究的总体目标是 设计和评估对社区孕妇实施艾滋病毒预防干预的策略 药房设置。在目标1中，我们建议进行一项离散选择实验，以量化对 提供艾滋病毒预防干预措施(包括预防接种计划、性传播感染筛查和治疗以及合作伙伴检测) 社区药房中的孕妇。将使用潜在类别分析来量化女性的状态 偏好和确定干预组件包，以优化不同亚组之间的摄取 对女人来说。在目标2中，我们将确定可能影响实施 最佳干预方案和选择改进执行情况的战略。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展到社区的潜在成本 一系列不同干预方案(目标1)和实施战略(目标)下的药房设置 2)。建议的研究目标补充了我在(1)社区艾滋病毒模型设计方面的培训目标 预防干预提供；(2)陈述偏好理论和方法及离散选择的应用 实验，(3)执行科学，特别是执行战略设计，和(4)先进 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 将使我能够作为未来R01的一部分，试行测试和评估 以药房为基础的向孕妇提供艾滋病毒预防干预的模式。我的长期目标是 成为独立的实施科学家，设计新的护理模式来实施和推广艾滋病毒 对孕妇的预防干预。以及来自跨学科的杰出专业知识 指导团队和华盛顿大学良好的培训和研究环境，这一职业 发展奖为我开始独立研究员的职业生涯提供了坚实的基础。

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.