Start the conversation: A multi-level PrEP initiative for Black women in NOLA

项目总结 路易斯安那州黑人顺性女性的艾滋病毒诊断率几乎是白人的7倍 顺性女性。迫切需要多层次的执行战略，以减少在 路易斯安那州新奥尔良的黑人顺性妇女(NOLA)是结束疫情的优先管辖权。vbl.使用 我们最近对黑人顺性女性进行的定性采访的结果以及来自 诺拉的黑人妇女和PrEP工作组，我们已经确定了限制PrEP使用的两个主要障碍 在NOLA的黑人顺性别女性中：(1)黑人顺性别女性不知道其他黑人顺性别女性 服用PrEP的妇女，以及(2)在常规医疗期间不提供PrEP的顺性黑人妇女。至 针对这些决定因素，我们建议制定和试点启动对话倡议，包括 患者和提供者层面的实施策略。目标1侧重于发展患者层面的 实施战略，一项社交媒体活动。与黑人妇女和PrEP工作队合作，并 一个专门从事社交媒体活动的当地社区组织，我们将确定 社交媒体消息的内容和要使用的社交媒体的类型。我们将进行4次焦点小组讨论 与黑人顺性女性讨论，以预先测试社交媒体内容。目标2专注于开发 提供商级实施策略。我们将开发一种综合护理PrEP模式，鼓励GYN 住院医生(1)开始与患者进行PrEP对话，并帮助他们确定PrEP是否适合 他们，和(2)帮助他们的患者确定PrEP随访的最佳位置-无论是通过妇科 住院医师诊所或常规的PrEP提供者。我们将对GYN进行12次深度访谈(IDI)，并 常规PrEP提供者，并建立由GYN住院医生、GYN驻院主任和现有人员组成的工作组 准备提供者告知综合护理PrEP模式。在目标3中，我们将评估 启动对话倡议。我们将在路易斯安那州立大学(LSU)GYN试行这些策略 为期8个月的实习计划，以告知可接受性、可行性和潜在影响。我们将首先 实施提供者级别的策略，然后层层实施患者级别的策略，以检查对患者的影响 需求(PrEP摄取)和保留。综合实施的8个月将与PrEP进行比较 来自杜兰大学妇科诊所的对比研究；护理结果中的一个月保留期将在 路易斯安那大学。实施成果(采用、保真度、维护)将通过图表审查和 与常驻反馈会议进行三角定位。我们还将进行24次IDI，每个人都有提供者(n=12)和 患者(n=12)，进一步告知可接受性、可行性和适宜性。在R34的末尾，我们计划 提交更大的实施研究提案，并在美国南部增加站点以评估这些项目 优化社区确定的实施战略。

PROJECT SUMMARY The rate of HIV diagnosis among Black cisgender women in Louisiana is almost 7 times higher than of White cisgender women. Multi-level implementation strategies are critically needed to reduce HIV infections among Black cisgender women in New Orleans, Louisiana (NOLA), an Ending the Epidemic priority jurisdiction. Using findings from our recently-conducted qualitative interviews with Black cisgender women and contributions from NOLA’s Black Women and PrEP Task Force, we have identified two main barriers that limit PrEP uptake among Black cisgender women in NOLA: (1) Black cisgender women do not know of other Black cisgender women taking PrEP, and (2) Black cisgender women are not offered PrEP during routine medical care. To address these determinants, we propose to develop and pilot a Start the Conversation Initiative that includes implementation strategies at the patient and provider levels. Aim 1 focuses on developing the patient-level implementation strategy, a social media campaign. Working with the Black Women and PrEP Task Force and a local community-based organization that specializes in social media campaigns, we will determine the content of the social media messages and the type of social media to use. We will conduct 4 focus group discussions with Black cisgender women to pre-test the social media content. Aim 2 focuses on developing the provider-level implementation strategies. We will develop a combined-care PrEP model that encourages GYN residents to (1) start a PrEP conversation with their patients and help them to determine if PrEP is right for them, and (2) help their patients to determine the best location of PrEP follow-up—either with the GYN residency clinic or with a routine PrEP provider. We will conduct 12 in-depth interviews (IDIs) with GYN and routine PrEP providers and establish a working group of GYN residents, GYN residency directors, and current PrEP providers to inform the combined-care PrEP model. In Aim 3, we will evaluate the implementation of the Start the Conversation Initiative. We will pilot the strategies at the Louisiana State University (LSU) GYN residency program over an 8-month period to inform acceptability, feasibility and potential impact. We will first implement the provider-level strategies, then layer in the patient-level strategies to examine impact on patient demand (PrEP uptake) and retention. The 8 months of combined implementation will be compared to PrEP uptake from a comparison GYN clinic at Tulane; one month retention in care outcomes will be measured at LSU. Implementation outcomes (adoption, fidelity, maintenance) will be assessed through chart review and triangulated with resident feedback sessions. We will also conduct 24 IDIs each with providers (n=12) and patients (n=12) to further inform acceptability, feasibility and appropriateness. At the end of the R34, we plan to submit a larger implementation research proposal with additional sites in the U.S. South to evaluate these optimized community-identified implementation strategies.