PrEP 4 Her: Developing a Novel Strategy to Implement PrEP into Women's Healthcare

PrEP 4 Her：制定新策略将 PrEP 实施到女性医疗保健中

• 批准号: 10682433
• 负责人: Latesha Ellen Elopre
• 金额: $ 25.72万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-13 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10682433
• 关键词: AIDS prevention; Address; Adoption; Affect; Age; Alabama; Appointment; Area; Awareness; Behavior Therapy; Belief; Black race; Caring; Clinic; Clinical Services; Collaborations; Communicable Diseases; Communication Methods; Communities; Data; Decision Making; Diagnosis; Disparity; Effectiveness; Epidemic; Event; FDA approved; Family Planning; Feedback; Focus Groups; Funding; Gays; Geographic Locations; Geography; Gynecologic; Gynecologist; Gynecology; HIV; HIV diagnosis; HIV disparities; HIV/AIDS; Health Care Visit; Healthcare; Heterosexuals; Improve Access; Incidence; Individual; Inequity; Interdisciplinary Study; Interview; Knowledge; Link; Low income; Manuscripts; Medical; Methodology; Methods; Nurses; Outcome; Persons; Pharmacists; Pharmacy facility; Phase; Physicians; Pilot Projects; Prevention; Prevention strategy; Process; Process Assessment; Provider; Psychology; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reproductive Health; Research; Research Design; Research Personnel; Risk; Schedule; Service delivery model; Services; Sexual Health; Site; Specialist; Strategic Planning; Surveys; Techniques; United States; United States National Institutes of Health; Universities; Visit; Vulnerable Populations; Woman; Women' s Health; Work; arm; behavioral economics; black women; cis-female; cisgender; clinical care; community engaged research; community engagement; epidemiologic data; experimental study; health care availability; health inequalities; implementation determinants; implementation evaluation; implementation measures; implementation outcomes; implementation science; implementation strategy; implementation study; implementation trial; improved; informant; innovation; intervention mapping; men who have sex with men; novel strategies; pre-exposure prophylaxis; preference; primary care provider; primary health service; programs; racial minority population; response; routine care; rural counties; screening; service delivery; social stigma; telehealth; therapy development; tool; transmission process; trend; uptake

PROJECT SUMMARY HIV disproportionately affects Black cis-gender women, especially in the Southern United States (US). HIV pre- exposure prophylaxis (PrEP) was approved by the FDA in 2012 and is an effective prevention tool able to decrease HIV transmission up to 92% among cis-gender women. However, there has been minimal PrEP uptake among racial minority groups and inequitable utilization in the South. With implementation of behavioral interventions, primarily focused on demand creation (i.e. community distribution, scheduling PrEP appointments during events celebrating gay pride, etc.), PrEP utilization among almost all groups except Black cis-gender women has improved. Given these inequities, there is an urgent need to better understand how to improve PrEP utilization among Black cis-gender women in geographic locations with the greatest need, like the South. Black cis-gender women have significant individual-level barriers to PrEP utilization, including but not limited to low HIV/PrEP knowledge, PrEP stigma, and low perceived need. Programs to implement PrEP in Title X family planning clinics, where cis-gender women already receive routine care, provide attractive venues to improve access. However, in PrEP implementation studies at these clinic sites, while improvement in provider-knowledge and PrEP referrals occurred, PrEP uptake was still low when on-site services were not available. While more research is needed to improve PrEP access in family planning clinics that specialize in women’s healthcare, in states like Alabama, where clinics receiving Title X funding are currently not providing PrEP services, additional strategies are needed. Gynecology clinics offer an ideal setting for PrEP care as a part of routine reproductive and sexual health care. Gynecologists already provide primary health care services for many cis-gender women, oftentimes in place of a primary care provider, making this clinic setting ideal for integration of PrEP services tailored for Black women. Our implementation study is informed by compelling preliminary data from almost 800 Black cis-gender women living in Alabama using discrete choice experiment methodology, which determined their desired PrEP services would be delivered in a clinical care setting by a gynecologist, rather than telehealth or pharmacy based programs. The proposed study will pursue three specific aims: (1) Evaluate key determinants for implementation of PrEP into gynecology clinic settings through concurrent mixed-methods; (2) Develop and refine a multi-component implementation strategy to integrate PrEP in routine women’s health visits (i.e. PrEP4Her) and (3) Pilot PrEP4Her at a gynecology clinic. We will measure implementation outcomes grounded in the RE-AIM framework, incorporating constructs from Proctor et al, including: reach, efficacy, acceptability, fidelity, adoption and preliminary effectiveness. Upon completion of our proposed research, our inter-disciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research and psychology, will be primed to lead a multi-site type III implementation trial of PrEP service delivery at gynecology clinics across the South.

项目摘要 艾滋病毒不成比例地影响黑人顺性别妇女，特别是在美国南部。艾滋病毒前 暴露预防（PrEP）于2012年获得FDA批准，是一种有效的预防工具， 将顺性别妇女的艾滋病毒传播率降低92%。然而，PrEP的摄入量很少， 少数民族群体之间的不平等和南方的不公平使用。通过实施行为 干预措施，主要集中在需求创造（即社区分布，安排PrEP预约 在庆祝同性恋骄傲的活动中等），PrEP在几乎所有群体中的利用率，黑人除外 女性得到了改善。鉴于这些不公平现象，迫切需要更好地了解如何改善PrEP 在需求最大的地理位置（例如南方）的黑人顺性别女性中的利用率。黑色 顺性别女性在PrEP利用方面存在显著的个人层面障碍，包括但不限于低 艾滋病毒/PrEP知识，PrEP耻辱，低感知需求。在Title X系列中实施PrEP的计划 规划诊所，在那里顺性别妇女已经接受例行护理，提供了有吸引力的场所，以改善 access.然而，在这些诊所的PrEP实施研究中， 和PrEP转介发生时，PrEP吸收仍然很低时，现场服务不可用。而更多 需要进行研究，以改善专门从事妇女保健的计划生育诊所的PrEP获取， 像亚拉巴马这样的州，接受Title X资助的诊所目前不提供PrEP服务， 需要战略。妇科诊所为PrEP护理提供了理想的环境，作为常规生殖保健的一部分。 和性保健。妇科医生已经为许多顺性别妇女提供了初级卫生保健服务， 通常代替初级保健提供者，使该诊所环境成为PrEP服务整合的理想选择 为黑人女性量身定做我们的实施研究是由来自近800个国家的令人信服的初步数据提供的。 黑人顺性别妇女生活在亚拉巴马使用离散选择实验方法， 他们想要的PrEP服务将由妇科医生在临床护理环境中提供，而不是远程医疗 或基于药房的方案。拟议的研究将追求三个具体目标：（1）评估关键决定因素 通过并行混合方法将PrEP实施到妇科诊所环境中;（2）开发和 完善一项多组成部分的实施战略，将PrEP纳入常规妇女健康检查（即 PrEP 4 Her）和（3）在妇科诊所试点PrEP 4 Her。我们将根据实际情况衡量执行成果 在RE-AIM框架中，结合了来自普罗克特等人的结构，包括：范围、功效、可接受性， 忠实、采用和初步效力。在完成我们提出的研究后，我们的跨学科 该小组包括传染病、实施科学、社区参与的研究和 心理学，将准备领导一个多站点的第三类实施试验的PrEP服务提供在妇科 南方的诊所。