Physician Attitudes toward New Biomedical HIV Prevention Interventions in Youth

医生对青年新的生物医学艾滋病毒预防干预措施的态度

• 批准号: 9335414
• 负责人: Tanya L. Kowalczyk Mullins
• 金额: $ 12.94万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-19 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9335414
• 关键词: 21 year old; AIDS prevention; AIDS/HIV problem; Address; Adolescent; Adolescent Medicine; Adolescent Medicine Trials Network; Adolescent and Young Adult; Adopted; Adult; Advisory Committees; Affect; Anti-Retroviral Agents; Area; Attitude; Automobile Driving; Basic Science; Behavior; Behavioral; Caring; Childhood; Clinical; Clinical Investigator; Clinical Research; Committee Members; Complement; Counseling; Data; Data Collection; Development; Development Plans; Diffusion of Innovation; Effectiveness; Environment; Ethics; Faculty; Funding; Future; Goals; Grant; HIV; HIV Infections; Health; Healthy People 2020; Human immunodeficiency virus test; Incidence; Individual; Infection; Infection prevention; Intention; International; Intervention; Intervention Studies; Interview; Journals; K-Series Research Career Programs; Knowledge; Light; Local Microbicides; Manuscripts; Master of Science; Medical center; Mentors; Mentorship; Methodology; Methods; New Agents; Oral; Outcome; Patients; Pediatric Hospitals; Pharmaceutical Preparations; Phase; Physician' s Role; Physicians; Planning Theory; Play; Policies; Preparation; Prevention; Prevention Measures; Prevention strategy; Preventive; Preventive Intervention; Primary Care Physician; Primary Health Care; Primary Prevention; Public Health; Publishing; Qualitative Methods; Recommendation; Research; Research Infrastructure; Research Methodology; Research Personnel; Research Training; Resources; Role; Sampling; Sexual Health; Sexually Transmitted Diseases; Structure; Survey Methodology; Surveys; Testing; Training; United States; United States National Institutes of Health; Validation; Work; Youth; adolescent HIV prevention; age group; base; career; career development; clinical epidemiology; design; experience; health disparity; improved; medical specialties; meetings; member; microbicide; novel; pediatrician; pre-exposure prophylaxis; prevent; prevention service; program dissemination; public health relevance; reproductive health of adolescents; skills; theories; therapy design; therapy development; uptake; vaginal microbicide

DESCRIPTION (provided by applicant): Between 2006 and 2009, the incidence of human immunodeficiency virus (HIV) infections increased significantly among adolescents and young adults. Although new biomedical primary prevention agents such as microbicides and pre-exposure prophylaxis (PrEP) decrease rates of HIV acquisition in trials, their effective-ness in practice will depend largely on clinician recommendations. However, despite the recent FDA approval of the first oral PrEP agent, data are not available regarding physician knowledge and attitudes about these methods with regard to use in youth. Physician intention to recommend these agents to adolescents, which is likely to be a powerful predictor of actual recommendations, is also unknown. This lack of data is a significant problem because the information will be critical to the design of interventions to improve the rate at which physicians recommend these agents to adolescents, an age group disproportionately affected by HIV infection. Dr. Mullins's long-term goal is to decrease HIV acquisition among adolescents through an independent research career focusing on the successful dissemination and uptake of new biomedical prevention agents. The candidate has demonstrated strong potential to conduct research. She has been the first-author for 5 pri- mary research manuscripts published in high-impact pediatric journals and presented her findings at national and international research meetings. She developed basic research skills through coursework culminating in a Master of Science in Epidemiology/Clinical Research. The overall objective of this K23 application, which is the next step toward attainment of the candidate's long-term goal, is to define the factors that influence physician intention to recommend microbicides and PrEP to adolescents. The central hypothesis is that physicians will have low intention to recommend microbicides and PrEP to adolescents, and factors such as knowledge, cur- rent HIV prevention practices, attitudes, subjective norm, and structural/policy factors will influence these inten- tions. The rationale underlying the proposed research is that, once the factors that influence intention to rec- ommend new agents are understood, such information can be used to design interventions that accelerate recommendations for new HIV prevention agents among clinicians who care for adolescents, which in turn will decrease adolescent HIV acquisition. The proposed research involves primary data collection using a mixed methods approach to explore and quantify physician attitudes toward and intentions to recommend new bio- medical HIV prevention agents to youth and to identify factors associated with these intentions. In the first phase, individual interviews will be conducted with 40 physicians who provide primary care to adolescents in order to explore and define the salient attitudes. The findings from this phase will inform the development of a new, validated survey designed to quantify physician attitudes and intentions with regard to recommending and prescribing microbicides and PrEP to adolescents for HIV prevention. In the final phase, the new survey will be administered to a national sample of 2500 physicians who provide primary care to adolescents to assess inten- tions to recommend and prescribe microbicides and PrEP and define predictors of these intentions. The pro- posed research will contribute novel information regarding the factors that influence physician intention to rec- ommend new prevention agents. The results will inform tailored interventions to educate physicians about these agents in order to maximize adolescent HIV prevention efforts and also will be applicable in the devel- opment of interventions to improve dissemination of other HIV prevention measures in development. In order to achieve her long-term career goal and the objectives of this application, the candidate will require training in mixed methods research (including qualitative and survey methods), health disparities, eth- ics of sexual health research, use of antiretroviral medications, and design/implementation of intervention stud- ies. These needs will be met through a combination of strong mentorship, didactics, and clinical experience. The mentorship team includes researchers with expertise in relevant content areas and mentoring junior facul- ty. Dr. Jessica Kahn, the primary mentor, provides expertise in prevention of sexually transmitted infections in adolescents and methodologic expertise in (1) the assessment of physician intentions to recommend STI pre- vention agents and (2) qualitative and survey research methods. She holds current R01 funding and is an ac- tive investigator and leader in the Adolescent Medicine Trials Network for HIV/AIDS Interventions. Dr. Kahn has successfully mentored many trainees and junior faculty. Her expertise will be complemented by that of the co-mentors and advisory committee members. The scientific environment at Cincinnati Children's Hospital Medical Center (CCHMC) provides an ideal setting for Dr. Mullins to achieve research independence. CCHMC has supported numerous junior investiga- tors, and 36 faculty hold NIH career development awards. The Division of Adolescent Medicine, which has seven NIH-funded faculty members and a focus on adolescent reproductive health research, had $1.7 million in grant support in 2011. The Division provides infrastructure and a wealth of intellectual resources for the de- velopment of the candidate. In summary, the candidate's demonstrated potential for research, novel research plan, relevant career development plan, excellent mentorship team, and outstanding research environment contribute to her ability to achieve research independence with the essential support provided by a K23 career development award.

描述（由申请人提供）：2006年至2009年期间，青少年和年轻人中人类免疫缺陷病毒（HIV）感染的发病率显著增加。虽然新的生物医学一级预防剂，如杀微生物剂和暴露前预防（PrEP）在试验中降低了艾滋病毒感染率，但其在实践中的有效性在很大程度上取决于临床医生的建议。然而，尽管最近FDA批准了第一种口服PrEP制剂，但没有关于医生对这些方法在青年中使用的知识和态度的数据。医生向青少年推荐这些药物的意图也是未知的，这可能是实际建议的有力预测因素。 数据的缺乏是一个重要的问题，因为这些信息对于设计干预措施以提高医生的治疗率至关重要。 建议青少年使用这些药物，这是一个受艾滋病毒感染影响特别大的年龄组。 马林斯博士的长期目标是通过独立的研究生涯，重点是成功传播和吸收新的生物医学预防剂，减少青少年感染艾滋病毒。候选人表现出很强的研究潜力。她是5篇pri-玛丽研究论文的第一作者，论文发表在影响力很大的儿科期刊上，并在国家和国际研究会议上发表了她的研究结果。她通过课程学习发展了基本的研究技能，最终获得了流行病学/临床研究硕士学位。这K23应用程序的总体目标，这是朝着实现候选人的长期目标的下一步，是确定影响医生的意图，建议杀微生物剂和PrEP青少年的因素。中心假设是医生对青少年推荐使用杀微生物剂和PrEP的意愿较低，知识、当前的HIV预防实践、态度、主观规范和结构/政策因素等因素会影响这些意愿。这项研究的基本原理是，一旦了解了影响推荐新药物意向的因素，这些信息就可以用来设计干预措施，加速在照顾青少年的临床医生中推荐新的艾滋病毒预防药物，这反过来又会减少青少年艾滋病毒感染。拟议的研究涉及使用混合方法收集原始数据，以探索和量化医生对向青年推荐新的生物医学艾滋病毒预防剂的态度和意图，并确定与这些意图相关的因素。在第一阶段，将与40名为青少年提供初级保健的医生进行个人访谈，以探索和定义突出的态度。本阶段的调查结果将 为制定一项新的、经过验证的调查提供信息，该调查旨在量化医生在向青少年推荐和开处方杀微生物剂和PrEP以预防艾滋病毒方面的态度和意图。在最后阶段，新的调查将对2500名为青少年提供初级保健的医生进行全国抽样，以评估推荐和处方杀微生物剂和PrEP的意图，并确定这些意图的预测因素。这项研究将为影响医生推荐新预防药物的因素提供新的信息。研究结果将为量身定制的干预措施提供信息，以教育医生了解这些药物，从而最大限度地提高青少年艾滋病毒预防工作，并将适用于制定干预措施，以改善其他艾滋病毒预防措施在发展中的传播。 为了实现她的长期职业目标和本申请的目标，候选人将需要在混合方法研究（包括定性和调查方法）、健康差异、性健康研究伦理学、抗逆转录病毒药物的使用以及干预研究的设计/实施方面进行培训。这些需求将通过强有力的指导，教学和临床经验的结合得到满足。导师团队包括在相关内容领域具有专业知识的研究人员，并指导初级教师。主要导师Jessica Kahn博士提供预防青少年性传播感染的专业知识和方法学专业知识，包括（1）评估医生推荐STI预防药物的意图和（2）定性和调查研究方法。她目前拥有R 01基金，是艾滋病毒/艾滋病干预青少年医学试验网络的积极研究者和领导者。卡恩博士成功地指导了许多学员和初级教师。她的专业知识将得到共同导师和咨询委员会成员的补充。 辛辛那提儿童医院医疗中心（CCHMC）的科学环境为Mullins博士实现研究独立性提供了理想的环境。CCHMC支持了许多初级教师，36名教师持有NIH职业发展奖。青少年医学部有7名NIH资助的教员，重点是青少年生殖健康研究，2011年获得了170万美元的赠款支持。该司为候选人的发展提供基础设施和丰富的智力资源。总之，候选人表现出的研究潜力，新颖的研究计划，相关的职业发展计划，优秀的导师团队和优秀的研究环境有助于她实现研究独立的能力，并得到K23职业发展奖的必要支持。

项目成果

Oral Pre-Exposure Prophylaxis (PrEP) for HIV Prevention in Adolescents and Young Adults.

• DOI: 10.1007/s40124-018-0163-x
• 发表时间: 2018-06
• 期刊: Current pediatrics reports
• 影响因子: 1.9
• 作者: Mullins TLK;Lehmann CE
• 通讯作者: Lehmann CE