Start the conversation: A multi-level PrEP initiative for Black women in NOLA

项目摘要 路易斯安那州黑人顺性别妇女的艾滋病毒诊断率几乎是白色的7倍 顺性别女性迫切需要多层次的执行战略，以减少艾滋病毒感染， 路易斯安那州新奥尔良的黑人顺性别妇女（NOLA），一个结束流行病的优先管辖区。使用 我们最近对黑人顺性别妇女进行的定性访谈的结果， NOLA的黑人妇女和PrEP工作组，我们已经确定了限制PrEP吸收的两个主要障碍 在NOLA的黑人cisgender妇女中：（1）黑人cisgender妇女不知道其他黑人cisgender 服用PrEP的妇女，和（2）黑人顺性别妇女在常规医疗护理期间不提供PrEP。到 为了解决这些决定因素，我们建议制定和试行“开始对话倡议”，其中包括 在患者和提供者层面的实施策略。目标1侧重于发展患者层面 执行战略、社会媒体宣传活动。与黑人妇女和PrEP工作队合作， 一个专门从事社交媒体活动的当地社区组织，我们将确定 社交媒体消息的内容和要使用的社交媒体的类型。我们将进行4个焦点小组 与黑人cisgender妇女讨论，以预先测试社交媒体内容。目标2侧重于开发 供应商一级的实施战略。我们将开发一个综合护理PrEP模型，鼓励妇科 居民（1）开始与他们的患者进行PrEP对话，并帮助他们确定PrEP是否适合 他们，和（2）帮助他们的病人，以确定最佳位置的准备后续行动-无论是与妇科 住院医生诊所或常规PrEP提供者。我们将与GYN进行12次深度访谈（IDI）， 常规PrEP提供者，并建立GYN居民工作组，GYN居民主任， PrEP提供者告知综合护理PrEP模型。在目标3中，我们将评估 启动对话倡议。我们将在路易斯安那州州立大学（LSU）妇产科试行这些策略 在为期8个月的驻留计划，以告知可接受性，可行性和潜在的影响。我们将首先 实施提供者层面的策略，然后分层纳入患者层面的策略，以检查对患者的影响 需求（PrEP摄取）和保留。8个月的合并实施将与PrEP进行比较 从杜兰的比较妇科诊所摄取;一个月的护理结果保留将在 路易斯安那州立大学。实施结果（采用、保真度、维护）将通过图表审查进行评估， 与居民反馈会议进行三角测量。我们还将进行24个IDI，每个IDI与供应商（n=12）和 患者（n=12），以进一步告知可接受性、可行性和适当性。在R34结束时，我们计划 提交一份更大的实施研究计划，在美国南部增加更多的地点，以评估这些 优化社区确定的实施战略。

PROJECT SUMMARY The rate of HIV diagnosis among Black cisgender women in Louisiana is almost 7 times higher than of White cisgender women. Multi-level implementation strategies are critically needed to reduce HIV infections among Black cisgender women in New Orleans, Louisiana (NOLA), an Ending the Epidemic priority jurisdiction. Using findings from our recently-conducted qualitative interviews with Black cisgender women and contributions from NOLA’s Black Women and PrEP Task Force, we have identified two main barriers that limit PrEP uptake among Black cisgender women in NOLA: (1) Black cisgender women do not know of other Black cisgender women taking PrEP, and (2) Black cisgender women are not offered PrEP during routine medical care. To address these determinants, we propose to develop and pilot a Start the Conversation Initiative that includes implementation strategies at the patient and provider levels. Aim 1 focuses on developing the patient-level implementation strategy, a social media campaign. Working with the Black Women and PrEP Task Force and a local community-based organization that specializes in social media campaigns, we will determine the content of the social media messages and the type of social media to use. We will conduct 4 focus group discussions with Black cisgender women to pre-test the social media content. Aim 2 focuses on developing the provider-level implementation strategies. We will develop a combined-care PrEP model that encourages GYN residents to (1) start a PrEP conversation with their patients and help them to determine if PrEP is right for them, and (2) help their patients to determine the best location of PrEP follow-up—either with the GYN residency clinic or with a routine PrEP provider. We will conduct 12 in-depth interviews (IDIs) with GYN and routine PrEP providers and establish a working group of GYN residents, GYN residency directors, and current PrEP providers to inform the combined-care PrEP model. In Aim 3, we will evaluate the implementation of the Start the Conversation Initiative. We will pilot the strategies at the Louisiana State University (LSU) GYN residency program over an 8-month period to inform acceptability, feasibility and potential impact. We will first implement the provider-level strategies, then layer in the patient-level strategies to examine impact on patient demand (PrEP uptake) and retention. The 8 months of combined implementation will be compared to PrEP uptake from a comparison GYN clinic at Tulane; one month retention in care outcomes will be measured at LSU. Implementation outcomes (adoption, fidelity, maintenance) will be assessed through chart review and triangulated with resident feedback sessions. We will also conduct 24 IDIs each with providers (n=12) and patients (n=12) to further inform acceptability, feasibility and appropriateness. At the end of the R34, we plan to submit a larger implementation research proposal with additional sites in the U.S. South to evaluate these optimized community-identified implementation strategies.