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

叙述/摘要 黑人少女和年轻妇女感染艾滋病毒的风险很高。抗病毒 暴露前预防药物（PrEP）是一种有效的，女性控制的策略， 减少感染艾滋病毒的风险，但吸收率很低。结束艾滋病毒流行（EtHE） 作为UAB艾滋病研究中心的补充，我们调查和采访了在艾滋病研究中心工作的卫生保健提供者。 在亚拉巴马。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、提供者和社区对性行为的污名化，获得性服务的挑战， 历史，PrEP适应症和管理方面的培训有限，以及与保险相关的结构性限制。 使用干预地图和能力-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，PrEP适应症的循证课程 和有效性;技能建设和面向客户的工具，以获得性史;和供应商PrEP冠军 创建一个多组件的特定环境的供应商干预，PrEP-Pro。在目标1中，我们将调整PrEP-Pro 由于家庭医学学员在照顾处于过渡阶段的青少年方面的作用， 为农村医疗卫生做出贡献。我们专注于培训居民，以利用学员的心态和精力 同时为家庭医学劳动力提供知情的PrEP提供者。我们将召集一个顾问委员会 提供者，PrEP冠军，AGYW和诊所管理员，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 目标2，我们将对最多12名家庭医学住院医师和2名PrEP进行改编的PrEP-Pro内容的预测试 农村和城市AL的冠军，并根据他们通过调查和深入研究的反馈进一步磨练PrEP-Pro 采访然后，我们将与60名家庭医学住院医生进行一项开放试验。试点的主要成果是 可接受性和可行性。我们还将衡量PrEP知识和态度以及PrEP处方 在干预前后的6个月期间，监测艾滋病毒/性传播感染的模式和艾滋病毒/性传播感染检测。在目标3中，我们将阐明 通过与供应商，AGYW和其他人进行深入访谈，确定PrEP-Pro实施的决定因素 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额外的投入 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发展，以及一个由妇女和非裔美国人领导的团队， 在南方腹地工作、生活、教学和提供护理的临床科学家，我们有能力 完成拟议的科学，向主要利益相关者和决策者传播信息，并应用 这些数据为在南方腹地减轻AGYW艾滋病毒感染的干预措施提供信息。

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.