Training in implementation science research to improve PrEP services for people at risk for HIV

项目摘要/摘要 有效管理艾滋病毒护理和预防的战略已经存在，但有许多以证据为基础 干预措施，如暴露前预防(PrEP)，没有足够规模地应用于实践，未能达到 最需要帮助的人。实施科学(IS)寻求弥合研究和实践之间的差距，以 确保循证干预措施在规模上得到有效转化。信息系统的方法正在迅速发展； 学员需要有专门时间和研究平台的导师来提供学习和应用信息系统的机会 当他们朝着独立的研究事业努力时，他们的方法。在这份提案中，雪莉·利普曼博士，助理 加州大学旧金山分校的驻校教授建议：1)扩大她的指导计划，包括正式培训 获得指导能力，以提高她在职业生涯早期提供的培训的深度和深度 科学家；2)扩大自己的利益相关者参与计划，研究重点是改进的方法 通过解决基于诊所和卫生系统的障碍，为服务不足的人群提供准备服务 关心；以及3)为加州大学旧金山分校的项目和海外合作研究机构提供早期职业科学家 有一个训练IS方法的平台。利普曼博士建立了一个专注于社会行为的研究组合 制定干预措施，支持个人和动员社区接受艾滋病毒检测，预防， 和护理，主要是在巴西和南非。这个K24以病人为中心的研究包括探索 执行研究综合框架(CFIR)中的上下文域，以确定 巴西S圣保罗跨性别妇女(TGW)诊所和诊所接生情况 南非阿金库尔的青春期少女和年轻妇女(目标1)。这项工作随后包括 利益相关者参与的过程，以达成一套拟议的实施战略，以改进PrEP 根据专家提供的分类，提供便于采用和维护PrEP的服务 实施变革的建议(ERIC)项目(目标2)。最后，战略将在一个地点试行。 在每个地点的诊所评估可行性、可接受性和监测流程，为更大规模的试验做准备 (R01)评估选定的策略是否改善PrEP的传递、摄取和维护。这个 研究重点是巴西TGW和南非AGYW的PrEP交付，因为两者都是 艾滋病毒发病率高，对艾滋病毒护理的参与度低，尽管表示有兴趣使用PrEP，但对PrEP的接受率较低。 利普曼博士在这两个领域都有广泛的合作，包括NIH支持的工作，并可以确保 在美国早期职业研究人员中提供大量指导和激励新研究的机会 还有两个国家。总而言之，K24为利普曼博士提供了一个机会，以扩大她的研究 通过实施消除在诊所和卫生系统环境中实施PrEP的障碍 为每个站点量身定做的战略，同时建立她的指导计划，以确保 具有在IS新兴领域建立新职业和进行科学探索的技能的调查人员。

PROJECT SUMMARY/ABSTRACT Strategies for effective management of HIV care and prevention exist, however many evidence-based interventions, such as Pre-exposure prophylaxis (PrEP), are not sufficiently scaled into practice, failing to reach those most in need. Implementation science (IS) seeks to bridge the gap between research and practice to ensure that evidence-based interventions are translated effectively at scale. IS methods are rapidly evolving; trainees require mentors with dedicated time and research platforms to offer opportunities to learn and apply IS methods as they work towards independent research careers. In this proposal Dr. Sheri Lippman, Associate Professor in Residence at UCSF, proposes to: 1) expand her mentoring program, including formal training to attain mentoring competencies, to improve the breathe and depth of the training she offers early career scientists; 2) expand her own program of stakeholder-engaged IS research focused on means to improving PrEP delivery to populations who are underserved through addressing clinic- and health system-based barriers to care; and 3) provide early career scientists in UCSF programs and collaborating research institutions abroad with a platform to train in IS methods. Dr. Lippman has built a research portfolio focused on social-behavioral intervention development, supporting individuals and mobilizing communities to uptake HIV testing, prevention, and care, mostly in Brazil and South Africa. The patient-oriented research in this K24 includes exploring contextual domains from the Consolidated Framework for Implementation Research (CFIR) to characterize the PrEP delivery context in clinics attending transgender women (TGW) in São Paulo, Brazil, and clinics attending adolescent girls and young women (AGYW) in Agincourt, South Africa (Aim 1). The work then includes stakeholder engaged processes to arrive at a proposed set of implementation strategies to improve PrEP service delivery that facilitates PrEP uptake and maintenance based on the taxonomies from the Expert Recommendations for Implementing Change (ERIC) Project (Aim 2). Finally, strategies will be piloted at one clinic in each site to assess feasibility, acceptability, and monitoring processes to prepare for larger trials (R01s) that evaluate whether selected strategies improve PrEP delivery, uptake, and maintenance. The research focuses on PrEP delivery for TGW in Brazil and AGYW in South Africa as both are populations who have high HIV incidence, poor engagement in HIV care, and low uptake of PrEP despite stated interest in use. Dr. Lippman has extensive collaborations, including NIH-supported work, in both areas and can ensure abundant opportunities for mentoring and stimulating new research among early career investigators in the US and both countries. In sum, this K24 provides an opportunity for Dr. Lippman to expand her IS research to address barriers to PrEP delivery in the clinic and health-system environment through implementation strategies tailored to each site, concurrently building her mentoring program to ensure a pipeline of investigators with skills to establish new careers and scientific inquiry in the burgeoning field of IS.