PrEP Pro: Adapting a multi-component intervention to train and support providers to promote PrEP for adolescent girls and young women in the Deep South

叙事/摘要 黑人少女和年轻妇女(AGYW)感染艾滋病毒的风险很高。抗逆转录病毒 暴露前药物预防(PrEP)是一种有效的、由女性控制的策略，可以显著 降低感染艾滋病毒的风险，但接受率很低。资金来自结束艾滋病毒流行(Ethe) 作为UAB艾滋病研究中心的补充，我们调查并采访了工作的卫生保健提供者 在阿拉巴马州。我们的数据表明，供应商不考虑将PrEP处方给Black AGYW。重要 障碍包括客户、提供者和社区对于性的污名，获得性行为的挑战 历史，关于PrEP适应症和管理的有限培训，以及与保险有关的结构限制。 使用干预映射和能力-机会-动机-行为模型 行为改变，我们建议调整艾滋病毒流行病学的循证课程，PrEP适应症 和有效性；获取性史的技能培养和面向客户的工具；以及提供商PrEP冠军 要创建多组件特定于上下文的提供者干预，PrEP-Pro。在目标1中，我们将采用PrEP-Pro 家庭医学实习生在过渡阶段和实质性阶段对青少年的照顾作用 对农村医疗保健的贡献。我们专注于培训住院医师，以利用学员的心态和精力 同时向家庭医学工作人员提供PrEP知情提供者。我们将召集一个顾问委员会 由提供商、PrEP冠军、AGYW和诊所管理员组成，以使现有内容适应当地环境。 我们将通过焦点小组讨论征求供应商和AGYW对PrEP-Pro内容的反馈。在……里面 目标2，我们将与最多12名家庭医学住院医生和2名PrEP预测试经过调整的PrEP-Pro内容 农村和城市AL的冠军，并根据他们通过调查和深入的反馈进一步磨练PrEP-Pro 采访。然后，我们将在60名家庭医学住院医生中进行一项开放试点。试点的主要成果是 可接受性和可行性。我们还将衡量PrEP的知识和态度以及PrEP处方 干预前后6个月的模式和HIV/STI检测。在目标3中，我们将阐明 通过与提供商、AGYW和其他机构进行深入访谈，确定实施PrEP-Pro的决定因素 主要利益相关者，与我们的CAB一起审查调查结果，并通过传播活动寻求更多投入 为未来的混合有效性/实施试验提供信息。 在青少年健康，性健康，成人医学教育，PrEP，定性方法， 社区参与的研究和干预开发以及由妇女和非裔美国人领导的团队 临床医生-在南方腹地工作、生活、教学和提供护理的科学家，我们处于有利地位 完成建议的科学，向主要利益相关者和政策制定者传播信息，并应用 这些数据为干预措施提供信息，以减轻南方腹地AGYW的艾滋病毒。

Narrative/Abstract Black adolescent girls and young women (AGYW) are at high-risk for HIV acquisition. Antiretroviral medication for pre-exposure prophylaxis (PrEP) is an effective, female-controlled strategy to dramatically reduce HIV-acquisition risk, but uptake is low. With funding from an Ending the HIV Epidemic (EtHE) supplement to the UAB Center for AIDS Research, we surveyed and interviewed health care providers working in Alabama. Our data suggest that providers do not consider prescribing PrEP to Black AGYW. Important barriers include client, provider, and community stigma around sexuality, challenges of obtaining a sexual history, limited training on PrEP indications and management, and structural limitations related to insurance. Using the Intervention Mapping, and the Capability-Opportunity-Motivation-Behavior model for behavioral change, we propose to adapt evidence-based curriculum on HIV epidemiology, PrEP indications and efficacy; skills building and client-facing tools for obtaining sexual histories; and provider PrEP Champions to create a multi-component context-specific provider intervention, PrEP-Pro. In Aim 1, we will adapt PrEP-Pro to Family Medicine trainees due to their role in caring for adolescents at stages of transition and substantial contributions to rural healthcare. We focus on residents in training to leverage trainee mindset and energy while seeding the Family Medicine workforce with PrEP informed providers. We will convene an advisory board of providers, PrEP Champions, AGYW, and clinic administrators to adapt existing content to the local context. We will solicit feedback on PrEP-Pro content from providers and AGYW through focus group discussions. In Aim 2, we will pre-test the adapted PrEP-Pro content with up to 12 Family Medicine residents and 2 PrEP Champions in rural and urban AL and further hone PrEP-Pro based on their feedback via surveys and in-depth interviews. We will then conduct an open pilot with 60 Family Medicine residents. Primary pilot outcomes are acceptability and feasibility. We will also measure PrEP knowledge and attitudes as well as PrEP prescribing patterns and HIV/STI testing in the 6-month periods pre- and post-intervention. In Aim 3 we will elucidate determinants to PrEP-Pro implementation by conducting in-depth interviews with providers, AGYW, and other key stakeholders, reviewing findings with our CAB, and seeking additional input through dissemination events to inform a future hybrid effectiveness/implementation trial. With expertise in adolescent health, sexual health, adult medical education, PrEP, qualitative methods, community-engaged research, and intervention development and a team led by women and African-American clinician-scientists who work, live, teach, and provide care in the Deep South, we are well-positioned to complete the proposed science, disseminate information to key stakeholders and policy makers, and apply these data to inform interventions to mitigate HIV for AGYW in the Deep South.