Identifying Community-Informed DoxyPEP Implementation Strategies to Guide Equitable Delivery of Syphilis Prevention

确定社区知情的 DoxyPEP 实施策略，以指导公平地提供梅毒预防

• 批准号: 10727777
• 负责人: Moira McNulty
• 金额: $ 22.46万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-24 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10727777
• 关键词: Address; Adoption; Affect; Antibiotics; Attitude; Behavior; Black Populations; Black race; Characteristics; Chicago; Clinic; Communities; Community Health; Consolidated Framework for Implementation Research; Contact Tracing; Data; Development; Doxycycline; Early identification; Education; Eligibility Determination; Ensure; Epidemic; Equity; Evidence based intervention; Face; Future; HIV; Health; Health Priorities; Health Services; Health Status; Health system; Hispanic; Illinois; Individual; Inequity; Infection; Interview; Knowledge; Latinx; Latinx population; Locales; Methods; Modeling; Morbidity - disease rate; Motivation; Patient Preferences; Patients; Population; Prevention; Prevention strategy; Prophylactic treatment; Provider; Public Health; Qualitative Methods; Research; Self Efficacy; Sex Behavior; Sexual Health; Sexual and Gender Minorities; Structure; Surveys; Syphilis; Testing; United States; Work; behavior change; burden of illness; effectiveness evaluation; experience; gender minority group; health equity; implementation barriers; implementation framework; implementation research; implementation science; implementation strategy; innovation; interest; men; men who have sex with men; novel; oral HIV; patient population; people of color; pre-exposure prophylaxis; pressure; prevent; provider-level barriers; research study; response; service delivery; sex; social; stem; syndemic; tool; transgender women; transgender women who have sex with men; transmission process; uptake

Project Summary/Abstract In this R21 proposal, we will use implementation science approaches to study delivery of equitable syphilis prevention, doxycycline post-exposure prophylaxis (doxyPEP), in a clinic-based setting. Innovative strategies for syphilis prevention are needed to address the growing national epidemic, with disproportionate burden of disease among Black and Hispanic/Latinx sexual and gender minority persons (SGM) who have sex with men. In Chicago specifically, syphilis rates have been rising steadily, syndemic with HIV transmission. Existing public health responses – contact tracing, testing, and treatment – have not stemmed these rising rates. Recent data show that doxycycline, taken after sexual activity, is very effective at prevention of syphilis for those who may be exposed. As an emerging evidence-based intervention, key implementation information is needed to ensure equitable delivery of doxyPEP to maximize impact on the syphilis epidemic. As has been recognized with other biomedical prevention tools such as HIV pre-exposure prophylaxis, early identification of barriers to delivery is imperative. The proposed study will address gaps in doxyPEP delivery using implementation frameworks in partnership with an SGM-focused health system in Chicago, Illinois, to meet the following aims: 1) Assess determinants of doxyPEP use at the patient, provider and health system levels; 2) Identify and select community- informed implementation strategies to support doxyPEP use among populations most affected by the syphilis epidemic; and 3) Develop and evaluate acceptability, feasibility, and appropriateness of a doxyPEP implementation strategy package among patients, providers, and health systems stakeholders. Our mixed methods approach will be rooted in the Consolidated Framework for Implementation Research (CFIR) and the Capability, Opportunity, and Motivation Model of Behavior (COM-B), incorporating qualitative methods and conjoint analysis approaches, to identify important determinants of doxyPEP service delivery. The proposed research will result in implementation strategies to guide equitable use of doxycycline post-exposure prophylaxis among populations most impacted by syphilis.

项目总结/摘要 在这个R21提案中，我们将使用实施科学方法来研究公平的梅毒交付。 预防，多西环素暴露后预防（doxyPEP），在临床为基础的设置。创新战略 需要预防梅毒，以解决日益增长的全国流行病，疾病负担不成比例 在与男性发生性关系的黑人和西班牙裔/拉丁裔性少数和性别少数群体中。在 特别是芝加哥，梅毒的发病率一直在稳步上升，与艾滋病毒传播的并发症。现有公共 卫生应对措施-接触者追踪、检测和治疗-并没有遏制这些上升的发病率。最近的数据 表明性活动后服用强力霉素对那些可能患有梅毒的人非常有效， 暴露了作为一种新兴的循证干预措施，需要关键的实施信息，以确保 公平提供doxyPEP，以最大限度地发挥对梅毒流行的影响。正如其他人所承认的那样， 生物医学预防工具，如艾滋病毒暴露前预防，早期识别分娩障碍， 势在必行拟议的研究将使用以下实施框架来解决doxyPEP交付方面的差距： 与伊利诺伊州芝加哥以SGM为重点的卫生系统建立伙伴关系，以实现以下目标：1）评估 在患者、提供者和卫生系统层面使用doxyPEP的决定因素; 2）确定和选择社区- 在受梅毒影响最严重的人群中支持使用doxyPEP的知情实施战略 流行病;和3）开发和评估doxyPEP的可接受性，可行性和适当性 在患者、提供者和卫生系统利益攸关方之间实施战略包。我们的混合 方法方法将植根于实施研究综合框架（CFIR）和 能力、机会和动机行为模型（COM-B），结合定性方法和 联合分析方法，以确定doxyPEP服务提供的重要决定因素。拟议 研究将产生实施战略，以指导多西环素暴露后预防的公平使用 在受梅毒影响最严重的人群中。