Implementation and Dissemination of Evidence-Based Interventions to Improve PrEP Care Continuum Outcomes Among Women in Community Health Clinics in the Southern U.S.

实施和传播循证干预措施，以改善美国南部社区健康诊所妇女的 PrEP 护理连续性结果

• 批准号: 10676120
• 负责人: Amy Kristen Johnson
• 金额: $ 54.8万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676120
• 关键词: AIDS prevention; Address; Adopted; Awareness; Black Populations; Black race; Clinic; Clinical; Community Health; Continuity of Patient Care; Disparity; Dissemination and Implementation; Education; Eligibility Determination; Epidemic; Evidence based intervention; Exploration, Preparation, Implementation, and Sustainment; HIV; HIV Infections; HIV diagnosis; HIV risk; High Risk Woman; Incidence; Individual; Inequity; Intervention; Knowledge; Measures; Midwestern United States; Neighborhood Health Center; Outcome; Patients; Phase; Preparation; Prevention approach; Provider; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research Methodology; Risk; Self Perception; Standardization; Training; United States; Woman; Work; black women; cis-female; design; effectiveness outcome; electronic medical record tool; gender disparity; geographic disparity; health care settings; hybrid type 2 design; implementation framework; implementation measures; implementation outcomes; implementation research; implementation science; implementation strategy; improved; men; men who have sex with men; pre-exposure prophylaxis; primary care setting; racial disparity; research study; satisfaction; scale up; success; transgender women; uptake

Significant disparities in pre-exposure prophylaxis (PrEP) for HIV prevention exist in the U.S. with cisgender women making up a disproportionately low percentage of PrEP users compared to men. 60% of new HIV diagnoses among women are among Black women, the majority of whom reside in the South. Challenges exist at each step of the PrEP care continuum, including difficulty identifying cisgender women at highest risk for HIV who are most likely to benefit from PrEP, low self-perception of HIV risk, low levels of PrEP knowledge, and barriers to PrEP initiation and persistence. While there has been growing knowledge of interventions to increase PrEP use among men who have sex with men and transgender women, much less is known about successful strategies to increase uptake and support PrEP persistence among Black cisgender women. Through preliminary work, our team has identified a set of successful strategies for PrEP Optimization among Women to Enhance Retention and Uptake (POWER Up) in community health center (CHC) settings, consisting of routine PrEP education for Black cisgender women, standardized provider training, electronic medical record tools for identifying women who would benefit from PrEP and tracking PrEP outcomes, and PrEP navigation. With These POWER Up strategies, a CHC network in the Midwest has more than doubled PrEP uptake among Black cisgender women and maintained PrEP persistence rates above the national average. These strategies have not been studied in CHCs with a large population of Black cisgender women outside of the Midwest. Therefore, we propose to refine, implement, and evaluate the impact of a CHC-focused intervention to improve PrEP care continuum outcomes for Black cisgender women in the Southern US, using implementation science research methods. Guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) implementation science framework, we will undertake the following aims: 1) Preparation: Adapt previously identified successful implementation strategies for engaging Black cisgender women in the PrEP care continuum in a Midwestern CHC for use in Southern CHCs. 2) Implementation: Via a hybrid type II design using the RE-AIM framework, measure the implementation and effectiveness outcomes of the adapted interventions in the Southern United States compared to the approach in the Midwest. We will complete a stepped wedge randomized controlled trial in 16 CHCs in the Midwest and South. 3) Sustainment and Spread: Develop an implementation guide that can be utilized across Southern U.S. jurisdictions to improve PrEP care continuum engagement among Black cisgender women reflecting the knowledge gained through adaptation. This will allow for rapid dissemination and replication of these strategies to improve PrEP care continuum outcomes among Black cisgender women.

在美国，顺性别人群在预防艾滋病毒的暴露前预防（PrEP）方面存在显著差异。 与男性相比，女性在PrEP使用者中所占比例不成比例地低。60%的新艾滋病毒 妇女中的诊断是黑人妇女，其中大多数居住在南方。存在挑战 在PrEP护理连续体的每一步，包括难以识别艾滋病毒风险最高的顺性别妇女 最有可能从PrEP中受益的人，对艾滋病毒风险的自我认知低，PrEP知识水平低，以及 PrEP启动和持续性的障碍。虽然人们对干预措施的了解越来越多， 在与男性发生性关系的男性和变性女性中增加PrEP的使用， 成功的战略，以增加吸收和支持准备持久性黑人cisgender妇女。 通过初步工作，我们的团队已经确定了一套成功的PrEP优化策略， 妇女在社区卫生中心环境中提高保留和吸收能力， 包括黑人cisgender妇女的常规PrEP教育，标准化的提供者培训，电子 用于识别将从PrEP中受益的女性并跟踪PrEP结果的医疗记录工具，以及 PrEP导航。通过这些POWER Up战略，中西部的CHC网络增长了一倍多 黑人顺性别妇女的PrEP摄取率，并保持PrEP持续率高于全国 指数.这些策略尚未在拥有大量黑人顺性别妇女的社区卫生中心进行研究 在中西部以外。因此，我们建议完善、实施和评估以社区卫生服务为重点的 干预措施，以改善美国南部黑人cisgender妇女的PrEP护理连续结果，使用 实施科学的研究方法。 以探索、准备、实施和维持（EPIS）实施科学为指导 框架，我们将进行以下目标：1）准备：适应以前确定的成功 实施战略，使黑人cisgender妇女在准备护理连续在中西部 CHC用于南部CHC。2)实施：通过使用RE-AIM框架的混合II型设计， 衡量南方联合国经调整的干预措施的执行情况和成效 与中西部的做法相比。我们将完成一个阶梯式楔形随机对照 在中西部和南部的16个社区卫生中心进行试验。3)维持和传播：制定实施指南 可以在美国南部司法管辖区使用，以改善PrEP护理连续参与， 黑人顺性别妇女反映了通过适应获得的知识。这将使快速 传播和复制这些策略，以改善黑人中的PrEP护理连续性结果 顺性别女性。

项目成果

POWER Up-Improving pre-exposure prophylaxis (PrEP) uptake among Black cisgender women in the Southern United States: Protocol for a stepped-wedge cluster randomized trial (SW-CRT).

美国南部黑色顺性妇女的曝光前预防预防（PREP）吸收的功率：阶梯式叶状群集随机试验（SW-CRT）的方案。

• DOI: 10.1371/journal.pone.0285858
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Ridgway, Jessica P. P.;Devlin, Samantha A. A.;Friedman, Eleanor E. E.;Enaholo, Ososese E. E.;Pyra, Maria;Hirschhorn, Lisa R. R.;Haider, Sadia;Ducheny, Kelly;Johnson, Amy K. K.
• 通讯作者: Johnson, Amy K. K.