TESTING A LAY COUNSELOR-LED PrEP DELIVERY MODEL IN PUBLIC HEALTH FACILITIES IN KENYA

项目摘要/摘要 拟议的K43奖项新兴全球领导者奖的总体目标是支持Dr。 伊丽莎白·伊伦古的研究培训，以发展为一名独立的全球卫生艾滋病毒研究员。 进行本申请中提出的研究将有助于她的培训目标：1)获得 在真实世界环境中设计和进行准实验研究的专业知识，2)获得 扎实的组织行为理论和研究基础；3)具备以下方面的专业知识 进行利益相关者分析。这项建议建立在她已经在临床上拥有的独特技能之上 试验、流行病学和实施学。这项提案的研究目标是测试一种 可改善公共HIV诊所PrEP流动和吸收的新PrEP交付方法 在肯尼亚。在非洲，PrEP正在被添加到已经负担过重的卫生基础设施中，并且 卫生系统建立可持续的PrEP方案的能力将需要提供服务 交付既省时又以病人为中心。虽然有很高的热情和对 在公共艾滋病毒诊所提供PrEP，然而，在这些诊所提供PrEP可以是 负担繁重，需要多次停顿(艾滋病毒检测、分类、临床审查和配药)和长时间 停留之间的等待时间和与在艾滋病毒诊所相关的耻辱。要解决这些问题 准备实施差距，Irungu博士将进行一项准实验研究，以测试 辅导员主导的PrEP交付模式将减少诊所的等待时间，改善PrEP 吸收和延续，并忠实地交付(目标1)。多达300个PrEP用户-均为新用户 启动和继续PrEP-将在两个为期12个月的连续观察期间登记 周期(N=150/周期)：1)标准护理PrEP产期(用作近 同期对照)和2)业馀辅导员主导的PrEP产程。深度访谈 将与参与试点诊所的医疗服务提供者一起进行，以阐明组织 实施这一新的PrEP交付模式的决定因素(目标2)。此外，关键的PrEP 通过利益相关者分析确定的肯尼亚交付利益相关者将接受采访，以 分类他们对非专业辅导员PrEP交付的兴趣以及影响PrEP交付的权力 政策，并了解他们对PrEP服务到Layer的任务转移的看法 辅导员。Irungu博士的研究目标与她的培训目标一致，并在完成这一任务后 获奖后，她将处于一个极好的地位，可以提交R01申请，进一步推动艾滋病毒的发展 预防实施研究。

PROJECT SUMMARY/ABSTRACT The overall goal of the proposed K43 award Emerging Global Leader Award is to support Dr. Elizabeth Irungu’s research training to develop as an independent global health HIV researcher. Conducting the study proposed in this application will facilitate her training goals to: 1) gain expertise in the design and conduct quasi-experimental studies in real world settings, 2) gain a solid foundation in organizational behavior theory and research, and 3) acquire expertise in conducting stakeholder analysis. This proposal builds on unique skills she already has in clinical trials, epidemiology and implementation science. The research goal of this proposal is to test a novel PrEP delivery approach that may improve the flow and uptake of PrEP in public HIV clinics in Kenya. In Africa, PrEP is being added to an already-burdened health infrastructure and the ability of the health systems to build sustainable PrEP programs will necessitate making service delivery both time-efficient and patient-centered. While there is high enthusiasm and uptake for PrEP delivered in public HIV clinics, the delivery of PrEP in these clinics, however, can be burdensome with multiple stops (for HIV testing, triage, clinical review, and dispensing) and long waiting times between stops and stigma associated with being in a HIV clinic. To address these PrEP implementation gaps, Dr Irungu will conduct a quasi-experimental study to test if a lay counselor-led PrEP delivery model will result in reduced waiting time in clinics, improved PrEP uptake and continuation and be delivered with fidelity (Aim 1). Up to 300 PrEP users – both newly initiating and continuing PrEP – will be enrolled during two serial, twelve-month observation periods (N=150/period): 1) a standard-of-care PrEP delivery period (to serve as a near- contemporaneous control) and 2) a lay-counselor led PrEP delivery period. In-depth interviews with health providers in participating pilot clinics will be conducted to elucidate organizational determinants of implementation of this novel PrEP delivery model (Aim 2). In addition, key PrEP delivery stakeholders in Kenya, identified through stakeholder analysis, will be interviewed to categorize their interest in lay counselor PrEP delivery and power to influence PrEP delivery policies, and to understand their perspectives about task shifting of PrEP services to lay counselors. Dr Irungu’s research goals align with her training goals and at the completion of this award, she will be in an excellent position to submit an R01 application to further advance HIV prevention implementation research.