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A Structural Approach to Improving HIV Pre-Exposure Prophylaxis (PrEP) Implementation among High Risk Men

改善高危男性 HIV 暴露前预防 (PrEP) 实施的结构性方法

基本信息

批准号：
10171915
负责人：
Julia Raifman
金额：
$ 13.28万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-11 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10171915
关键词：
AIDS prevention Address Administrator Adoption Affect Age Award Awareness Behavioral Biometry Boston Caring Centers for Disease Control and Prevention (U.S.)Cities Clinic Clinical Clinical Trials Computerized Medical Record Country Coupled Data Development Education Educational Status Employment Feedback Future Goals HIV HIV risk Health Health Personnel Health Policy Healthcare Hospital Administrators Institution Institutional Policy Institutional Practice International Internet Intervention Intervention Trial Interview Laws Lead Learning Lesbian Gay Bisexual Logistic Regressions Marriage Massachusetts Measures Mediating Mediation Mentorship Methods Outcome Patients Pediatrics Personal Satisfaction Physician Executives Policies Population Provider Public Health Informatics Public Health Schools Reporting Research Research Personnel Resources Rights Role Schools Sex Behavior Sex Orientation Sexual Health Statistical Methods Structure Surveys Time Training United States Universities Visual Woman base behavior influence black men who have sex with men black subgroup care providers career career development eVisit experience hate crimes health care settings health disparity health management high risk men improved lifetime risk male health men men who have sex with men novel pre-exposure prophylaxis prevent primary care setting professor prototype same-sex marriage screening sex sexual minority social social stigma surveillance data therapy development uptake young adult

项目摘要

PROJECT SUMMARY Dr. Raifman’s long-term career development goal is to become an independent researcher working to reduce sexual minority health disparities with a focus on reducing the burden of HIV among men who have sex with men (MSM). MSM in the United States have a lifetime risk of human immunodeficiency virus (HIV) nearly 80 times that of men who have sex with women, but just 4% reported using pre-exposure prophylaxis (PrEP) to prevent HIV in 2014. Structural stigma based on sexual orientation may contribute to slow PrEP uptake. Dr. Raifman will evaluate the role of structural stigma in MSM PrEP awareness and uptake and will develop and refine a clinic-level intervention to reduce structural stigma and improve PrEP uptake. She has the following research aims: (1) Assess state-level structural stigma and PrEP awareness and uptake among MSM through a difference-in-differences analysis; (2) Assess the relationship between sexual minority stigma in healthcare settings and PrEP awareness and uptake, and whether stigma in healthcare setting mediates any relationship between state-level stigma and PrEP awareness and uptake; and (3) Develop and refine a PrEP and structural stigma intervention for primary care settings. Dr. Raifman will use Centers for Disease Control and Prevention repeated cross-sectional National HIV Behavioral Surveillance Data collected from MSM in 21 cities and national Internet survey data from MSM collected by Fenway Health in 2013. She will also conduct qualitative interviews with clinic administrators, primary care providers, and MSM patients in Massachusetts and Georgia, states with differing levels of disparities in MSM health. The proposed research builds upon Dr. Raifman’s prior research on the health effects of structural stigma affecting sexual minorities, on HIV prevention and PrEP implementation, and on HIV treatment and care. She will pursue the following K01 training aims to prepare her for the proposed research and for her career goals: (1) Acquire training on health and social policymaking in the US; (2) Acquire high-level training in statistical methods for causal mediation analysis to evaluate different levels of stigma; (3) Acquire training on developing and evaluating multi-component, clinical interventions; and (4) Acquire training in health informatics in order to integrate interventions into electronic medical records. To achieve these training goals, Dr. Raifman has assembled a mentorship team lead by Dr. Michael Stein, the chair of Health Law, Policy, and Management at Boston University School of Public Health (BUSPH); Dr. Kenneth Mayer, Medical Director of Fenway Health; Dr. Colleen Barry, the Julie and Fred Soper Professor and Chair of Health Policy and Management at Johns Hopkins; and Dr. Debbie Cheng, BUSPH Professor of Biostatistics. Dr. Raifman’s training will prepare her to achieve her long-term career goal of becoming an independent investigator reducing the disproportionate burden of HIV and other health disparities among sexual minorities.

项目摘要 Raifman博士的长期职业发展目标是成为一名独立的研究人员，减少性少数群体的健康差距，重点是减少有性行为的男性中的艾滋病毒负担男同性恋（MSM）美国的男男性接触者一生中感染人类免疫缺陷病毒（HIV）的风险几乎与女性发生性关系的男性的80倍，但只有4%的人报告使用暴露前预防（PrEP）， 2014年预防艾滋病。基于性取向的结构性耻辱可能会导致PrEP吸收缓慢。博士 Raifman将评估结构性耻辱在MSM PrEP意识和吸收中的作用，并将开发和完善临床层面的干预措施，以减少结构性污名并提高PrEP的吸收率。她有以下内容研究目标：（1）通过以下方式评估州一级的结构性污名和PrEP意识以及MSM的吸收情况差异中的差异分析;（2）评估医疗保健中的性少数耻辱感与环境和PrEP意识和吸收，以及医疗保健环境中的耻辱是否介导任何关系国家一级的耻辱和PrEP意识和吸收之间;（3）制定和完善PrEP和结构对初级保健机构的污名化干预。Raifman博士将使用疾病控制和预防中心重复的全国艾滋病行为监测数据收集自21个城市的男男性接触者， Fenway Health在2013年收集的MSM全国互联网调查数据。她还将进行定性对马萨诸塞州和格鲁吉亚的诊所管理人员、初级保健提供者和MSM患者进行访谈，在MSM健康方面存在不同程度差异的州。这项拟议中的研究建立在Raifman博士先前对结构性耻辱对健康影响的研究基础上艾滋病毒预防和PrEP实施以及艾滋病毒治疗和护理。她将进行以下K 01培训，旨在为拟议的研究和职业目标做好准备： (1)在美国获得关于卫生和社会决策的培训;（2）获得统计方面的高级培训因果中介分析方法，以评估不同程度的污名;（3）获得培训，和评价多组成部分，临床干预措施;和（4）获得卫生信息学的培训，以将干预措施纳入电子病历。为了实现这些目标，Raifman博士组建了一个由迈克尔·斯坦博士领导的导师团队，他是卫生法律，政策和管理的主席，波士顿大学公共卫生学院（BUSPH）; Kenneth Mayer博士，芬威健康医疗总监; 博士Colleen巴里，朱莉和弗雷德·索普教授，约翰大学卫生政策和管理主席霍普金斯;和Debbie Cheng博士，BUSPH生物统计学教授。Raifman医生的训练会让她实现她成为一名独立调查员的长期职业目标，减少不成比例的性少数群体的艾滋病毒负担和其他健康差距。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Higher COVID-19 Vaccination And Narrower Disparities In US Cities With Paid Sick Leave Compared To Those Without.

DOI：
10.1377/hlthaff.2022.00779
发表时间：
2022-11
期刊：
HEALTH AFFAIRS
影响因子：
9.7
作者：
Schnake-Mahl, Alina S.;O'Leary, Gabriella;Mullachery, Pricila H.;Skinner, Alexandra;Kolker, Jennifer;Roux, Ana V. Diez;Raifman, Julia R.;Bilal, Usama
通讯作者：
Bilal, Usama

Association of the Implementation of Child Tax Credit Advance Payments With Food Insufficiency in US Households.