PrEP Demonstration Project among Women at Risk for HIV Infection

针对艾滋病毒感染风险女性的 PrEP 示范项目

• 批准号: 10198705
• 负责人: MIRJAM-COLETTE KEMPF
• 金额: $ 23.24万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198705
• 关键词: AIDS prevention; Address; Adherence; Adult; Affect; African American; Alabama; Area; Awareness; Behavior Therapy; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Clinic; Communication Tools; Communities; Continuity of Patient Care; Data; Deep South; Development; Education; Epidemic; Evidence based intervention; Family Planning; Funding; Future; Goals; HIV; HIV Infections; HIV diagnosis; HIV risk; HIV/STD; Health; Health Services; Healthcare; High Risk Woman; Incidence; Individual; Intervention; Knowledge; Methods; Outcome; Persons; Population; Prevention; Primary Health Care; Provider; Randomized; Reproductive Health; Research; Risk; Rural; Sampling; Science; Services; Southeastern United States; Target Populations; Testing; Time; Underserved Population; United States National Institutes of Health; Woman; Women' s Health; Work; aged; care seeking; condoms; cost; effectiveness measure; ethnic minority population; experience; health care availability; health disparity; high risk; implementation process; implementation science; implementation trial; improved; infection rate; interest; male; men who have sex with men; microbicide; multidisciplinary; patient-clinician communication; post intervention; pre-exposure prophylaxis; preference; prevent; racial and ethnic; racial disparity; risk perception; rural area; rural counties; screening; service delivery; statistics; success; therapy design; tool; underserved rural area; uptake; urban area

PROJECT SUMMARY African-American (AA) women living in the Deep South are 10 times more likely to be infected with HIV than white women. Traditional HIV prevention methods, including STI/HIV education, comprehensive behavioral interventions, and provision of condoms have rendered minimal success in this population. HIV pre-exposure prophylaxis (PrEP) has become a promising biomedical prevention tool, with over 90% efficacy as shown in numerous trials. PrEP has the potential to curb incident HIV infection among at-risk women; however, biomedical HIV prevention work in the US has generally focused on men who have sex with men, often leaving women (particularly women of racial/ethnic minority status) underserved, and a disparity with respect to HIV infection inadequately addressed. Implementation science projects are urgently needed to evaluate and overcome barriers to PrEP awareness, uptake, adherence, and persistence in this population. The objective of this application is to increase PrEP uptake among AA women at-risk for HIV-infection in the rural South, specifically those seeking care at Federally Qualified Healthcare Centers (FQHC) in rural Alabama. We will use a mixed-methods approach to adapt and pilot test a patient-provider communication tool from the CDC PrEP toolkit that focuses on the first three steps of the PrEP cascade (e.g., recognizing HIV risk, identifying as a PrEP candidate, and interested in PrEP) to increase PrEP uptake via referrals to local PrEP clinics. Specifically, we propose: (1) to explore the HIV risk perceptions of AA women with recent PrEP use (N=15-25), AA women who are candidates for PrEP (N=15-25), and providers (N=20) and identify preferences around patient-provider communication about HIV risk and PrEP services that address the needs of AA women; (2A) To systematically adapt a patient-provider communication tool to increase PrEP uptake at two FQHCs in rural Alabama, using an iterative implementation process; and (2B). To assess the feasibility, acceptability, and preliminary impact of the patient-provider communication intervention on PrEP uptake among AA women and their providers in a pilot pre-/post-intervention design (N=250). As part of aim 2B), we will also systematically document and evaluate reasons for declining a PrEP referral, reasons for incomplete referrals, reasons for failing to initiate PrEP after a successful referral, and ongoing PrEP use at 3/6 months post PrEP initiation among our sample. The proposed work will significantly contribute to our understanding of factors impacting PrEP uptake and use among AA women at high-risk for HIV-infection, particularly in underserved, rural areas in the Deep South that are increasingly impacted by the HIV epidemic and have worse health outcomes relative to other areas in the US. The results of this work will also directly contribute to a full-scale, R01-level cluster randomized implementation trial in which we will measure the effectiveness and cost associated with a PrEP services delivery intervention serving AA women at-risk for HIV-infection in primary care and reproductive health centers in rural areas of the Deep South.

项目概要 生活在南方腹地的非裔美国 (AA) 女性感染艾滋病毒的可能性是普通女性的 10 倍 白人妇女。传统的艾滋病毒预防方法，包括性传播感染/艾滋病毒教育、综合行为 干预措施和提供安全套在这一人群中收效甚微。 HIV暴露前 预防（PrEP）已成为一种有前途的生物医学预防工具，其有效率超过 90%，如图所示 无数次的试验。 PrEP 有可能遏制高危妇女中的艾滋病毒感染事件；然而， 美国的生物医学艾滋病毒预防工作通常集中于男男性行为者，通常 使妇女（特别是少数种族/族裔妇女）得不到充分服务，并受到尊重 艾滋病毒感染问题没有得到充分解决。迫切需要实施科学项目来评估 并克服该人群中 PrEP 认知、吸收、依从性和持久性的障碍。这 该应用程序的目的是提高农村地区有艾滋病毒感染风险的 AA 妇女对 PrEP 的采用率 南方，特别是那些在阿拉巴马州农村地区的联邦合格医疗中心 (FQHC) 寻求护理的人。 我们将使用混合方法来调整和试点测试患者与提供者之间的沟通工具 CDC PrEP 工具包专注于 PrEP 级联的前三个步骤（例如，识别 HIV 风险、 确定为 PrEP 候选者，并且对 PrEP 感兴趣），通过转介到当地 PrEP 来增加 PrEP 的采用率 诊所。具体来说，我们建议：(1) 探讨近期使用 PrEP 的 AA 女性对 HIV 风险的认知 (N=15-25)、PrEP 候选人 (N=15-25) 的 AA 女性以及提供者 (N=20) 并确定 围绕患者与提供者关于 HIV 风险和 PrEP 服务沟通的偏好，以解决 AA 女性的需求； (2A) 系统地调整患者与提供者之间的沟通工具以增加 PrEP 阿拉巴马州农村地区的两个 FQHC 采用迭代实施流程进行吸收；和（2B）。评估 医患沟通干预对 PrEP 的可行性、可接受性和初步影响 AA 女性及其提供者在干预前/干预后试点设计中的采用率 (N=250)。作为目标的一部分 2B)，我们还将系统地记录和评估拒绝 PrEP 转介的原因、 不完整的转介、成功转介后未能启动 PrEP 的原因以及持续使用 PrEP 我们的样本中启动 PrEP 后 3/6 个月。拟议的工作将大大有助于我们 了解影响 HIV 感染高危 AA 女性接受和使用 PrEP 的因素， 特别是在服务欠缺的南部腹地农村地区，这些地区日益受到艾滋病毒流行的影响 与美国其他地区相比，其健康状况更差。这项工作的成果也将直接 为全面的 R01 级集群随机实施试验做出贡献，我们将在其中测量 与为有风险的 AA 妇女提供 PrEP 服务提供干预相关的有效性和成本 南部腹地农村地区初级保健和生殖健康中心的艾滋病毒感染情况。

项目成果

Protocol for WeExPAnd: a prospective, mixed-methods pilot demonstration study to increase access to pre-exposure prophylaxis among women vulnerable to HIV infection in the Southern USA.

• DOI: 10.1136/bmjopen-2023-075250
• 发表时间: 2023-06-07
• 期刊: BMJ OPEN
• 影响因子: 2.9
• 作者: Psaros, Christina;Goodman, Georgia R.;McDonald, Victoria Wright;Ott, Corilyn;Blyler, Abigail;Rivas, Alexa;Shan, Liang;Campbell, Marquetta;Underwood, Eric;Krakower, Douglas;Elopre, Latesha;Kudroff, Kachina;Sherr, Kenneth H.;Kempf, Mirjam-Colette
• 通讯作者: Kempf, Mirjam-Colette