Accelerating Equitable PrEP Delivery for Black Adults in Primary Care Settings: Development and Testing of A Practice-Level Multifaceted Implementation Strategy

项目摘要/摘要 美国必须采取实质性措施，纠正艾滋病毒暴露前的明显不平等现象 预防(PrEP)在黑人成年人中的结果。在黑人群体中实施PREP是 被根植于耻辱、种族主义、异性恋和 性别歧视。随着新模式的出现，改善初级保健计划的提供已成为当务之急。有一件急事 需要制定实施战略，以加快公平的PrEP交付。这款K23的目标是 为了促进沃森博士的长期目标，成为一名专注于 制定实施战略，以在黑人中实现公平的艾滋病毒预防结果 人口。拟议的K23将侧重于设计和测试多方面的实施战略 支持为黑人初级保健患者提供PrEP，以适应的概念框架为基础 这包括实施研究综合框架(CFIR)和 班杜拉的社会认知理论。沃森博士提出的研究计划将包括培训目标 (1)定性研究，(2)行为和社会科学研究(BSSR)，(3)社区参与 研究；(4)实施科学。重点放在以股权为中心的应用程序上 实施科学和社区参与的研究，她需要在质量方面的进一步培训 研究、BSSR和试验设计，以制定和试行一项实施战略，以增加当地PrEP 调配容量。这些培训目标将通过模范教师的指导来实现 多学科指导团队，互补的研究目标，专业发展活动，以及 课程作业。具体地说，她计划：(目标1)确定关键提供者、实践和社区层面的CFIR- 基于当地PrEP交付的决定因素；(目标2)制定一个有理论依据的多方面实施 遵循去污名化的性健康框架的战略，以加速公平地为 成年黑人初级保健患者；(目标3)进行为期12个月的双臂试点试验，以评估实施情况 提供初级保健服务的四家医疗机构的战略可行性和可接受性。结果是 这项研究对实施科学领域将是重要的，因为它侧重于促进理论-- 提供商和实践领导层之间的知情行为变化，以加快公平的PrEP提供 针对黑人初级保健患者。试验结果将为R01的设计和提交提供参考 申请混合成效--第4年实施战略的实施试验。 该提案将为沃森博士继续发展成为一家独立的 资助实施科学家的研究生涯，投资于实施的发展 在美国黑人成年人中实现公平的艾滋病毒预防护理结果的战略。

PROJECT SUMMARY/ABSTRACT Substantial measures must be taken in the United States to rectify the marked inequities in HIV pre-exposure prophylaxis (PrEP) outcomes among Black adults. PrEP implementation among Black populations is undermined by individual, interpersonal, and structural barriers rooted in stigma, racism, heterosexism, and sexism. Improving PrEP provision has become imperative as novel modalities emerge. There is an urgent need to develop implementation strategies that accelerate equitable PrEP delivery. The goal of this K23 is to facilitate Dr. Watson’s long-term goal to become an independent investigator focused on the development of implementation strategies to achieve equitable HIV prevention outcomes among Black populations. The proposed K23 will focus on designing and testing a multifaceted implementation strategy to support PrEP provision for Black primary care patients, grounded in an adapted conceptual framework that includes constructs from the Consolidated Framework for Implementation Research (CFIR) and Bandura’s Social Cognitive Theory. Dr. Watson’s proposed research plan will consist of training objectives in (1) qualitative research, (2) behavioral and social science research (BSSR), (3) community-engaged research, and (4) implementation science. With a focus on equity-centered applications within implementation science and community-engaged research, she requires further training in qualitative research, BSSR, and trial design to develop and pilot an implementation strategy to increase local PrEP provision capacity. These training objectives will be achieved through mentorship from an exemplary multidisciplinary mentorship team, complementary research aims, professional development activities, and coursework. Specifically, she plans to: (Aim 1) Identify key provider-, practice-, and community-level CFIR- based determinants of local PrEP delivery; (Aim 2) Develop a theory-informed multifaceted implementation strategy that follows a destigmatizing sexual health framework to accelerate equitable PrEP delivery for adult Black primary care patients; (Aim 3) Conduct a 12-month two-arm pilot trial to evaluate implementation strategy feasibility and acceptability at four medical practices that provide primary care services. The results of this study will be important for the field of implementation science as it focuses on facilitating theory- informed behavior changes among providers and practice leadership to accelerate equitable PrEP provision for Black primary care patients. Findings from the pilot will inform the design and submission of an R01 application for a hybrid effectiveness-implementation trial of the implementation strategy in year 4. The proposal will form a strong foundation for Dr. Watson’s continued development toward an independently funded research career as an implementation scientist invested in the development of implementation strategies to achieve equitable HIV prevention care outcomes among Black adults in the U.S.