Using Audience Segmentation to Identify Implementation Strategies to Improve PrEP Uptake Among At-Risk Cisgender Women

利用受众细分来确定实施策略，以提高高危顺性别女性对 PrEP 的接受率

• 批准号: 10401526
• 负责人: Jennifer Ann Pellowski
• 金额: $ 24.1万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10401526
• 关键词: AIDS prevention; African American; Area; Attitude; Characteristics; Clinic; Clinical; Data; Death Rate; Diagnosis; Ensure; Environmental Risk Factor; Epidemic; Family Planning; Future; Goals; HIV; HIV Infections; Health Personnel; Health Planning; Health Services; Healthcare; Heterogeneity; Incidence; Individual; Infection; Intervention Studies; Interview; Knowledge; Lesbian Gay Bisexual Transgender; Marketing; Methods; Pattern; Pharmaceutical Preparations; Population; Poverty; Prevalence; Prevention strategy; Preventive Health Services; Promoting Action on Research Implementation in Health Services framework; Provider; Public Health; Qualitative Methods; Readiness; Reproductive Health; Reproductive Health Services; Research; Risk; Role; Sampling; Science; Services; Sexual Health; Subgroup; Surveys; Testing; Time; To specify; Woman; Women' s Health; Women' s Health Services; Work; authority; base; care seeking; cis-female; clinical care; comorbidity; design; economic disparity; health care settings; health disparity; implementation determinants; implementation efforts; implementation facilitation; implementation framework; implementation science; implementation strategy; improved; infection rate; innovation; medication compliance; men who have sex with men; novel strategies; organizational climate; pre-exposure prophylaxis; racial disparity; recruit; response; service delivery; service providers; social stigma; transgender women; truvada; uptake; women of color

PROJECT ABSTRACT In the US, 18% of new HIV infections occur among cisgender women (cis-women), with these rates reaching as high as 30% in some parts of the U.S., however, only 7% of eligible cis-women have been prescribed pre- exposure prophylaxis (PrEP) for the prevention of HIV infection. Notably, areas with higher HIV incidence among cis women also have the lowest rates of PrEP uptake among this group. Unlike men who have sex with men or trans-women, cis-women are more likely to seek PrEP from a variety of clinical settings including ones that focus more on sexual and reproductive health and family planning, such as OB/GYN healthcare practices in addition to LGBT oriented services. There is a crucial need to develop the science of PrEP implementation in the context of sexual and reproductive health services for cis-women. Promising implementation strategies to improve PrEP delivery for women include targeting organizational/clinic factors, provider acceptability of PrEP as an HIV prevention strategy for cis-women, providers’ perceived scope of practice, and cis-women’s knowledge about specific considerations for PrEP. Audience segmentation is a novel approach that can assist in understanding this variability in implementation strategies, categorize sexual health providers based on their needs and organizational climates (audience segments), and to match these sub-populations to appropriate implementation strategies to increase the prescription of PrEP in order to curb HIV infection rates among at-risk cis-women. Utilizing a sequential mixed methods design and guided by the i-PARIHS framework, this study aims to develop implementation strategies that match the heterogenous needs of clinical providers in variable sexual health settings for increasing the uptake of PrEP among cis-women. Aim 1 will use qualitative methods (in-depth interviews sexual health providers working with cis-gender women who have prescriptive authority, PrEP eligible cis-women [cis-women on, and not currently on PrEP], and administrative stakeholders) to identify potential clinician characteristics and clinical environmental factors related to audience segments of sexual health providers. Qualitative findings will inform survey content to be used in Aim 2. Aim 2 includes quantitative surveys with ~340 sexual health providers, analyzed using latent class analysis to identify key audience segments based on providers’ patterns of responses, creating groups of individuals that have similar attitudes, needs, and organizational climates. Utilizing expert provider panels, Aim 3 seeks to match the audience segments to menus of implementation strategies suitable for the specific needs and organizational climates of these audience segments. The proposed study has the potential to make a significant contribution to our understanding of appropriate implementation strategies for the variable sexual health settings in which cis-women seek PrEP and the results of this study will provide innovative approaches for future applications focused on clinicians within healthcare settings designed to improve the implementation of PrEP for at-risk cis-women, a key population for effective HIV prevention strategies.

项目摘要 在美国，18%的新艾滋病毒感染发生在顺性别女性（cis-women）中， 在美国的一些地区高达30%，然而，只有7%的符合条件的cis妇女在 暴露预防（PrEP）用于预防HIV感染。值得注意的是， 顺式妇女在这一群体中的PrEP摄取率也最低。不像那些和男人发生性关系的男人， 跨性别女性，顺式女性更有可能从各种临床环境中寻求PrEP，包括那些专注于 更多关于性健康、生殖健康和计划生育的信息，如产科/妇科保健实践 LGBT导向服务有一个至关重要的需要，以发展科学的PrEP实施的背景下， 为非裔妇女提供性健康和生殖健康服务。改善PrEP的有希望的实施战略 为妇女提供包括针对组织/诊所因素，提供者对PrEP作为艾滋病毒的可接受性， 预防战略，为cis妇女，供应商的感知范围的做法，和cis妇女的知识， 受众细分是一种新的方法，可以帮助理解 实施策略的这种可变性，根据他们的需求对性健康提供者进行分类， 组织气候（受众群体），并将这些子人群与适当的实施相匹配 增加PrEP处方的战略，以遏制高危顺产妇女的艾滋病毒感染率。 本研究旨在利用顺序混合方法设计并在i-PARIHS框架的指导下开发 实施策略，以满足不同性健康的临床提供者的异质性需求 增加顺式妇女对PrEP的吸收。目标1将使用定性方法（深入 采访性健康提供者与顺性别妇女谁拥有规定的权力，PrEP合格 顺式妇女[顺式妇女，而不是目前的PrEP]，和行政利益相关者），以确定潜在的 与性健康受众相关的临床特征和临床环境因素 提供商定性调查结果将为目标2中使用的调查内容提供信息。目标2包括定量调查 约340名性健康提供者，使用潜在类别分析进行分析，以确定基于 提供者的反应模式，创建具有相似态度，需求和 组织气候。Aim 3利用专家提供商面板，寻求将受众群体与菜单相匹配 适合这些受众的具体需求和组织环境的实施战略 片段这项拟议的研究有可能对我们理解 为顺式妇女寻求PrEP的各种性健康环境制定适当的实施战略， 这项研究的结果将为未来的临床应用提供创新的方法， 旨在改善高危顺式妇女PrEP实施的医疗保健环境，这是一个关键人群， 有效的艾滋病毒预防战略。