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Health Coaching to Improve Comprehensive HIV and Sexually Transmitted Infection Prevention in Adolescent Primary Care

健康指导改善青少年初级保健中艾滋病毒和性传播感染的综合预防

基本信息

批准号：
9926511
负责人：
Sarah Marian Wood
金额：
$ 18.53万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-01 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9926511
关键词：
18 year old AIDS prevention Acquired Immunodeficiency Syndrome Address Adherence Adolescent Adolescent and Young Adult Advisory Committees Affect Age Applied Research Area Award Behavior Therapy Behavioral Behavioral Model Childhood Clinical Trials Clinical Trials Design Complement Counseling Data Development Diagnosis Ensure Epidemic Focus Groups Goals Guidelines HIV HIV Infections Health Health Care Costs Health Services Health system Hybrids Incidence Individual Intervention Interview Licensure Measurement Mental Depression Mental Health Mentors Mentorship Methodology Modeling National Institute of Mental Health Patients Plant Roots Population Positioning Attribute Postdoctoral Fellow Pragmatic clinical trial Prevention Prevention approach Preventive Intervention Preventive service Primary Health Care Process Provider Public Health Qualitative Methods Randomized Randomized Controlled Trials Recording of previous events Research Research Methodology Research Personnel Research Training Risk Risk Reduction STI prevention Science Scientist Self Efficacy Self Management Sexual Health Sexually Transmitted Diseases Structure Techniques Tenofovir Testing Time Training Training Programs United States United States Food and Drug Administration Wood material Youth adolescent HIV prevention adolescent sexual health aged base behavior change biobehavior care delivery care providers career career development comorbidity comparative efficacy comparison intervention effectiveness implementation study effectiveness implementation trial emtricitabine evidence base health care delivery health care service utilization high risk high-risk adolescents implementation research implementation science implementation strategy improved infection rate innovation intervention effect motivated behavior motivational enhancement therapy patient oriented pragmatic trial pre-exposure prophylaxis prevent prevention service programs scale up screening sexual HIV transmission sexual health intervention standard of care theories therapy development tool trial design uptake

项目摘要

PROJECT SUMMARY/ABSTRACT In the United States, HIV and sexually transmitted infections (STIs) disproportionately affect adolescents and young adults (AYA). Youth aged 13-24 years comprise ~21% of incident HIV cases. In addition, 2017 data demonstrated the fourth consecutive year of increasing STI rates, with the highest incidence occurring in AYA. Amidst these public health challenges, the 2018 licensure of tenofovir-emtricitabine as HIV pre-exposure prophylaxis (PrEP) for adolescents presents a key opportunity for enhancing youth HIV and STI prevention services. Currently, <2% of U.S. PrEP prescriptions are for adolescents <18 years of age. Pediatric primary care providers (PCPs) are thus well-positioned to expand PrEP delivery. However, sexual health service delivery in primary care is hampered by PCP time constraints and competing demands. There is a critical need for both behavioral interventions to increase PrEP uptake and reduce STIs in adolescents, and implementation strategies to disseminate PrEP and enhanced sexual health services in adolescent primary care. The goal of this K23 application is to facilitate Dr. Sarah M. Wood’s long-term goal of becoming an independent investigator in adolescent HIV and STI prevention through an integrated program of training and applied research that will prepare her to meet the challenges of the current HIV and STI epidemics. This award will also focus on her short-term goal of gaining the methodologic expertise needed to adapt, optimize for implementation, and test, a developmentally-tailored, PrEP-inclusive, HIV/STI prevention health coaching intervention for adolescents in primary care. The training objectives focus on content areas where she currently lacks the methodologic expertise to carry out this goal: 1) bio-behavioral intervention adaptation, 2) implementation science, and 3) clinical trial methodology. This training plan will be bolstered by a highly skilled mentorship team with expertise in intervention development, adolescent sexual health and qualitative methodology, and primary care pragmatic clinical trials. The advisory team will provide further expertise in developmental tailoring, prevention science, implementation science, mental health measurement and targets, and clinical trial design and analysis. Dr. Wood’s training objectives will progress in parallel with, and inform, her applied research aims. Aim 1 will use qualitative methods and the ADAPT-ITT framework to adapt the health coaching intervention. Aim 2 will determine acceptability and feasibility of the intervention among primary care providers, and develop an optimized primary care implementation strategy for the intervention. Finally, Aim 3 will conduct a small randomized controlled trial to test the intervention for change in prevention self-efficacy, as well as acceptability and feasibility and in adolescents with a history of STI. The culmination of Dr. Wood’s research and training will be the submission of a R01 application for a type I hybrid randomized effectiveness-implementation trial of the health coaching intervention.

项目摘要/摘要在美国，艾滋病毒和性传播感染 (STI) 不成比例地影响青少年和青少年年轻人 (AYA)。 13-24 岁的青少年占艾滋病毒感染病例的约 21%。此外，2017 年数据性传播感染发病率连续第四年上升，其中 AYA 的发病率最高。在这些公共卫生挑战中，2018 年替诺福韦-恩曲他滨作为 HIV 暴露前药物的许可青少年预防 (PrEP) 为加强青少年艾滋病毒和性传播感染预防提供了关键机会服务。目前，<2% 的美国 PrEP 处方适用于 18 岁以下的青少年。儿科初级保健因此，提供商 (PCP) 处于有利地位，可以扩大 PrEP 的交付。然而，性健康服务的提供初级保健受到 PCP 时间限制和相互竞争的需求的阻碍。两者都迫切需要增加青少年 PrEP 摄入和减少性传播感染的行为干预措施以及实施策略在青少年初级保健中传播 PrEP 并加强性健康服务。 K23 的目标申请是为了促进 Sarah M. Wood 博士成为一名独立调查员的长期目标通过培训和应用研究综合计划预防青少年艾滋病毒和性传播感染让她做好准备应对当前艾滋病毒和性传播感染流行病的挑战。这个奖项也将集中在她身上短期目标是获得适应、优化实施所需的方法专业知识，以及测试，一种针对发育量身定制、包含 PrEP 的 HIV/STI 预防健康指导干预措施初级保健中的青少年。培训目标侧重于她目前缺乏的内容领域实现这一目标的方法学专业知识：1) 生物行为干预适应，2) 实施科学，以及 3) 临床试验方法。该培训计划将得到高技能导师团队的支持拥有干预发展、青少年性健康和定性方法以及初级方面的专业知识护理务实的临床试验。顾问团队将提供发展定制方面的进一步专业知识，预防科学、实施科学、心理健康测量和目标以及临床试验设计和分析。伍德博士的培训目标将与她的应用研究目标并行发展，并为她提供信息。目标 1 将使用定性方法和 ADAPT-ITT 框架来调整健康指导干预措施。目的 2 将确定初级保健提供者对干预措施的可接受性和可行性，并制定优化初级保健干预实施策略。最后，目标 3 将进行一次小型的随机对照试验，测试干预措施对预防自我效能的改变以及可接受性以及在有性传播感染病史的青少年中的可行性。伍德博士的研究和培训的顶峰将提交 R01 申请，用于 I 型混合随机有效性实施试验健康指导干预。