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

在美国，在接触前预防(PrEP)预防艾滋病毒方面存在显著差异 与男性相比，女性在PrEP使用者中所占的比例低得不成比例。60%的新艾滋病毒 女性中的确诊病例发生在黑人女性中，她们中的大多数居住在南方。挑战存在 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妇女 谁最有可能从PrEP中受益，对艾滋病毒风险的自我认知较低，PrEP知识水平较低，以及 PrEP启动和持续的障碍。虽然对干预措施的了解越来越多，但 在与男性发生性关系的男性和变性人女性中增加PrEP的使用率，人们对此知之甚少 在黑人顺性妇女中增加摄取率和支持PrEP持久性的成功战略。 通过前期工作，我们的团队在以下方面确定了一套成功的PrEP优化策略 妇女在社区卫生中心(CHC)环境中增强留存和吸收(加电)， 包括对黑人顺性女性的常规PrEP教育，标准化提供者培训，电子 用于确定哪些妇女将受益于PrEP并跟踪PrEP结果的医疗记录工具，以及 准备导航。有了这些启动战略，中西部的CHC网络增加了一倍多 黑人顺性女性接受PREP并保持高于全国水平的PrEP持续率 平均水平。这些策略还没有在有大量黑人顺性女性人口的CHC中进行研究 在中西部以外。因此，我们建议细化、实施和评估以CHC为重点的 干预措施改善美国南部黑人顺性女性的PrEP连续护理结果，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 在这一框架下，我们将实现以下目标：1)准备：成功改编先前确定的内容 在中西部让黑人顺性妇女参与PrEP连续护理的实施战略 南方社区卫生中心使用的CHC。2)实施：通过使用RE-AIM框架的混合类型II设计， 衡量调整后的干预措施在美国南部的实施情况和成效 与中西部地区的做法相比，美国各州的情况有所不同。我们将完成阶梯状楔形随机对照 在中西部和南部的16个社区卫生中心进行了试验。3)可持续性和广泛性：制定实施指南 可以跨美国南部司法管辖区利用，以提高以下人员的PrEP护理连续性参与度 黑人顺性妇女反映了通过适应获得的知识。这将允许快速 传播和复制这些战略，以改善黑人的PrEP护理连续结果 顺性女性。

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.