PrEP 4 Her: Developing a Novel Strategy to Implement PrEP into Women's Healthcare

PrEP 4 Her：制定将 PrEP 纳入女性医疗保健的新策略

• 批准号: 10469513
• 负责人: Latesha Ellen Elopre
• 金额: $ 22.15万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-13 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10469513
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adoption; Affect; Age; Alabama; Appointment; Area; Awareness; Behavior Therapy; Belief; Black race; Caring; Clinic; Clinical Services; Collaborations; Communicable Diseases; Communication Methods; Communities; Data; Decision Making; Diagnosis; Effectiveness; Epidemic; Event; FDA approved; Family Planning; Feedback; Focus Groups; Funding; Gays; Geographic Locations; Geography; Gynecologic; Gynecologist; Gynecology; HIV; HIV diagnosis; Health Care Visit; Healthcare; Heterosexuals; Improve Access; Incidence; Individual; Interdisciplinary Study; Interview; Knowledge; Lead; Link; Low income; Manuscripts; Medical; Methodology; Methods; Nurses; Outcome; Persons; Pharmacists; Pharmacy facility; Phase; Physicians; Pilot Projects; Prevention; Prevention strategy; Primary Health Care; Process; Provider; Psychology; Reach Effectiveness Adoption Implementation and Maintenance; Reproductive Health; Research; Research Design; Research Personnel; Risk; Schedule; Service delivery model; Services; Sexual Health; Site; Specialist; Strategic Planning; Surveys; Techniques; Time; United States; United States National Institutes of Health; Universities; Visit; Vulnerable Populations; Woman; Women' s Health; Work; arm; base; behavioral economics; black women; care providers; cis-female; cisgender; clinical care; community engaged research; data format; epidemiologic data; experimental study; health care availability; health care service; health inequalities; implementation determinants; implementation evaluation; implementation measures; implementation outcomes; implementation science; implementation strategy; implementation study; implementation trial; improved; informant; innovation; intervention mapping; men who have sex with men; novel strategies; pre-exposure prophylaxis; preference; programs; racial minority population; response; routine care; rural counties; screening; service delivery; social stigma; telehealth; therapy development; tool; transmission process; trend; uptake

PROJECT SUMMARY HIV disproportionately affects Black cis-gender women, especially in the Southern United States (US). HIV pre- exposure prophylaxis (PrEP) was approved by the FDA in 2012 and is an effective prevention tool able to decrease HIV transmission up to 92% among cis-gender women. However, there has been minimal PrEP uptake among racial minority groups and inequitable utilization in the South. With implementation of behavioral interventions, primarily focused on demand creation (i.e. community distribution, scheduling PrEP appointments during events celebrating gay pride, etc.), PrEP utilization among almost all groups except Black cis-gender women has improved. Given these inequities, there is an urgent need to better understand how to improve PrEP utilization among Black cis-gender women in geographic locations with the greatest need, like the South. Black cis-gender women have significant individual-level barriers to PrEP utilization, including but not limited to low HIV/PrEP knowledge, PrEP stigma, and low perceived need. Programs to implement PrEP in Title X family planning clinics, where cis-gender women already receive routine care, provide attractive venues to improve access. However, in PrEP implementation studies at these clinic sites, while improvement in provider-knowledge and PrEP referrals occurred, PrEP uptake was still low when on-site services were not available. While more research is needed to improve PrEP access in family planning clinics that specialize in women’s healthcare, in states like Alabama, where clinics receiving Title X funding are currently not providing PrEP services, additional strategies are needed. Gynecology clinics offer an ideal setting for PrEP care as a part of routine reproductive and sexual health care. Gynecologists already provide primary health care services for many cis-gender women, oftentimes in place of a primary care provider, making this clinic setting ideal for integration of PrEP services tailored for Black women. Our implementation study is informed by compelling preliminary data from almost 800 Black cis-gender women living in Alabama using discrete choice experiment methodology, which determined their desired PrEP services would be delivered in a clinical care setting by a gynecologist, rather than telehealth or pharmacy based programs. The proposed study will pursue three specific aims: (1) Evaluate key determinants for implementation of PrEP into gynecology clinic settings through concurrent mixed-methods; (2) Develop and refine a multi-component implementation strategy to integrate PrEP in routine women’s health visits (i.e. PrEP4Her) and (3) Pilot PrEP4Her at a gynecology clinic. We will measure implementation outcomes grounded in the RE-AIM framework, incorporating constructs from Proctor et al, including: reach, efficacy, acceptability, fidelity, adoption and preliminary effectiveness. Upon completion of our proposed research, our inter-disciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research and psychology, will be primed to lead a multi-site type III implementation trial of PrEP service delivery at gynecology clinics across the South.

项目总结 艾滋病毒对黑人顺性女性的影响不成比例，特别是在美国南部。HIV Pre- 暴露预防(PrEP)于2012年获得FDA批准，是一种有效的预防工具，能够 将顺性女性中艾滋病毒的传播降低高达92%。然而，PrEP的摄取量很低 少数族裔群体之间的暴力和南方的不公平利用。通过实施行为 干预措施，主要侧重于创造需求(即社区分配、安排PrEP预约 在庆祝同性恋骄傲等活动期间)，除黑人顺性外，几乎所有群体都使用PrEP 女性的情况有所改善。鉴于这些不平等，迫切需要更好地了解如何改进PrEP 在有最大需求的地理位置，如南方，黑人顺势性别妇女的使用率。黑色 顺性别妇女在使用PrEP方面有重大的个人层面的障碍，包括但不限于低水平 HIV/PrEP知识、PrEP耻辱和低感知需求。在标题X系列中实施PrEP的计划 规划诊所，在那里顺性女性已经得到常规护理，提供了有吸引力的改善场所 进入。然而，在这些诊所站点的PrEP实施研究中，在改善提供者知识的同时 和PrEP转诊，当现场服务不可用时，PrEP接种率仍然较低。而更多的 需要进行研究，以改善专门从事妇女保健的计划生育诊所获得PrEP的机会 像阿拉巴马州这样的州，获得第X条资金的诊所目前不提供PrEP服务，另外 战略是必要的。妇科诊所为PrEP护理提供了一个理想的环境，作为常规生殖的一部分 和性健康护理。妇科医生已经为许多顺性别女性提供初级保健服务， 通常替代初级保健提供者，使该诊所环境成为PrEP服务集成的理想选择 为黑人女性量身定做的。我们的实施研究由来自近800个国家的令人信服的初步数据提供信息 居住在阿拉巴马州的黑人顺性女性使用离散选择实验方法，这确定了 他们想要的PrEP服务将由妇科医生在临床护理环境中提供，而不是远程医疗 或以药房为基础的项目。拟议的研究将追求三个具体目标：(1)评估关键决定因素 通过并行混合方法在妇科诊所实施PrEP；(2)开发和 完善多组成部分的实施战略，将PrEP纳入妇女的常规健康检查(即 PrEP4Her)和(3)妇科诊所的飞行员PrEP4Her。我们将扎扎实实地衡量实施成果 在RE-AIM框架中，纳入了Proctor等人的结构，包括：REACH、有效性、可接受性、 忠诚度、领养和初步效力。在完成我们建议的研究后，我们的跨学科 团队，其中包括传染病、实施科学、社区参与研究和 心理学，将领导妇科PrEP服务交付的多站点III型实施试验 遍布南方的诊所。