Delivery of PrEP to Key Populations in Kenya: Applying Coincidence Analysis to Determine Effective Implementation Strategies

项目摘要 自2012年以来，暴露前预防(PrEP)通常作为每日避孕药或最近作为双月避孕药提供 注射，已成为预防艾滋病毒的一种方法。尽管PrEP非常有效地减少了 对于个人感染艾滋病毒的风险，已采取了预防方法。在这项研究中，我们将检查 实施PrEP的现有计划，并评估哪些实施战略和背景因素导致 以最佳的PrEP启动率和持久率；这些发现将有助于改善PrEP的交付 以及肯尼亚正在进行的艾滋病毒预防工作。这项研究有两个目的：目的1)确定执行情况 影响临床和社区PrEP实施的策略和背景因素 肯尼亚的组织和AIM 2)确定实施战略和背景情况的组合(S 向感染艾滋病毒风险最大的人群提供最有效的PrEP的因素。至 实现目标1我们将分三个阶段收集和汇总数据。在阶段1中，我们将请求聚合 来自肯尼亚开出PrEP以衡量研究结果的组织的数据(即 开始使用PrEP并保持PrEP超过3个月和6个月的合格个人)和 确定可能影响实施战略和现场层面的背景因素的初步变化 准备实施。在第二阶段，我们将对部分地点的工作人员进行量化调查，以评估 实施研究综合框架(CFIR)因素和有无的影响 关于PrEP实施成果的实施战略。在第三阶段，我们将完成半结构化 访谈，以更详细和细致入微地了解实施战略和背景情况 来自第二阶段响应的因素。为了达到目标2，我们将进行符合分析(CNA)以确定 导致符合条件的个人比例较高的一套实施战略和背景因素 谁启动和维护PrEP(即优化实施)。CNA是一种因果推理的方法， 确定对感兴趣的结果最不必要或最充分的因素的组合。在……里面 在本应用程序中，我们将检查环境因素和实施策略的哪些组合 在优化的PrEP实施中。这些模型将基于以下三种结果运行： 启动PrEP的客户比例；以及在3个月和6个月后继续使用PrEP的客户比例， 它们中的每一个都将被一分为二(高与低)或三分(高、中、低)。其他内容 代表客户群体差异的因素(例如男男性接触者、女性、青年)将包括在 分析以确定独特的策略和因素集是否会导致对不同 人口。

Project Summary Since 2012, pre-exposure prophylaxis (PrEP), typically delivered as a daily pill or more recently as a bimonthly injection, has been available as a method of HIV prevention. Despite PrEP being highly effective at reducing a person’s risk of acquiring HIV, uptake of the prevention method has been. In this study we will examine existing programs implementing PrEP and assess which implementation strategies and contextual factors lead to the best rates of PrEP initiation and persistence; these findings will contribute to improving PrEP delivery and the ongoing HIV prevention efforts in Kenya. The study has two aims: Aim 1) Identify the implementation strategies and contextual factors affecting PrEP implementation within clinical and community-based organizations in Kenya and Aim 2) Determine the combination(s) of implementation strategies and contextual factors that produce the most effective delivery of PrEP to populations at greatest risk of HIV acquisition. To achieve Aim 1 we will collect and summarize data through three phases. In Phase 1 we will request aggregate data from organizations that prescribe PrEP in Kenya to measure the study outcomes (i.e., the proportions of eligible individuals who start PrEP and who have maintained PrEP use over 3-month and 6-month periods) and identify preliminary variation in the implementation strategies and site-level contextual factors that may affect PrEP implementation. In Phase 2 we will conduct quantitative surveys with staff at a subset of sites to assess the impact of Consolidated Framework for Implementation Research (CFIR) factors and presence or absence of implementation strategies on PrEP implementation outcomes. In Phase 3 we will complete semi-structured interviews to gain a more detailed and nuanced understanding of implementation strategies and contextual factors from Phase 2 responses. To achieve Aim 2 we will conduct Coincidence Analysis (CNA) to determine the sets of implementation strategies and contextual factors leading to high proportions of eligible individuals who both start and maintain PrEP (i.e., optimized implementation). CNA is a method of causal inference and determines the combinations of factors that are minimally necessary or sufficient for an outcome of interest. In this application we will examine which combinations of contextual factors and implementation strategies result in optimized PrEP implementation. The models will be run for three outcomes based on the following: proportion of clients who initiate PrEP; and proportion of clients continuing PrEP use after 3 and 6 months, each of which will either be dichotomized (high vs. low) or trichotomized (high, medium, low). Additional factors, representing differences in client populations (e.g., MSM, women, youth) will be included in the analyses to determine whether unique sets of strategies and factors lead to optimization for different populations.