PrEP Demonstration Project among Women at Risk for HIV Infection

针对艾滋病毒感染风险女性的 PrEP 示范项目

• 批准号: 10002300
• 负责人: MIRJAM-COLETTE KEMPF
• 金额: $ 23.71万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10002300
• 关键词: AIDS prevention; Address; Adherence; Adult; Affect; African American; Alabama; Area; Awareness; Behavior Therapy; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Clinic; Communication Tools; Communities; Continuity of Patient Care; Data; Deep South; Development; Education; Epidemic; Evidence based intervention; Family Planning; Funding; Future; Goals; HIV; HIV Infections; HIV diagnosis; HIV risk; HIV/STD; Health; Health Services; Healthcare; High Risk Woman; Incidence; Individual; Intervention; Knowledge; Methods; Outcome; Persons; Population; Prevention; Primary Health Care; Process; Provider; Randomized; Reproductive Health; Research; Risk; Rural; Sampling; Science; Services; Southeastern United States; Target Populations; Testing; Time; Underserved Population; United States National Institutes of Health; Woman; Women' s Health; Work; aged; care seeking; condoms; cost; effectiveness measure; ethnic minority population; experience; health care availability; health disparity; high risk; implementation science; implementation trial; improved; infection rate; interest; male; men who have sex with men; microbicide; multidisciplinary; patient-clinician communication; post intervention; pre-exposure prophylaxis; preference; prevent; racial and ethnic; racial disparity; risk perception; rural area; rural counties; screening; service delivery; statistics; success; therapy design; tool; underserved rural area; uptake; urban area

PROJECT SUMMARY African-American (AA) women living in the Deep South are 10 times more likely to be infected with HIV than white women. Traditional HIV prevention methods, including STI/HIV education, comprehensive behavioral interventions, and provision of condoms have rendered minimal success in this population. HIV pre-exposure prophylaxis (PrEP) has become a promising biomedical prevention tool, with over 90% efficacy as shown in numerous trials. PrEP has the potential to curb incident HIV infection among at-risk women; however, biomedical HIV prevention work in the US has generally focused on men who have sex with men, often leaving women (particularly women of racial/ethnic minority status) underserved, and a disparity with respect to HIV infection inadequately addressed. Implementation science projects are urgently needed to evaluate and overcome barriers to PrEP awareness, uptake, adherence, and persistence in this population. The objective of this application is to increase PrEP uptake among AA women at-risk for HIV-infection in the rural South, specifically those seeking care at Federally Qualified Healthcare Centers (FQHC) in rural Alabama. We will use a mixed-methods approach to adapt and pilot test a patient-provider communication tool from the CDC PrEP toolkit that focuses on the first three steps of the PrEP cascade (e.g., recognizing HIV risk, identifying as a PrEP candidate, and interested in PrEP) to increase PrEP uptake via referrals to local PrEP clinics. Specifically, we propose: (1) to explore the HIV risk perceptions of AA women with recent PrEP use (N=15-25), AA women who are candidates for PrEP (N=15-25), and providers (N=20) and identify preferences around patient-provider communication about HIV risk and PrEP services that address the needs of AA women; (2A) To systematically adapt a patient-provider communication tool to increase PrEP uptake at two FQHCs in rural Alabama, using an iterative implementation process; and (2B). To assess the feasibility, acceptability, and preliminary impact of the patient-provider communication intervention on PrEP uptake among AA women and their providers in a pilot pre-/post-intervention design (N=250). As part of aim 2B), we will also systematically document and evaluate reasons for declining a PrEP referral, reasons for incomplete referrals, reasons for failing to initiate PrEP after a successful referral, and ongoing PrEP use at 3/6 months post PrEP initiation among our sample. The proposed work will significantly contribute to our understanding of factors impacting PrEP uptake and use among AA women at high-risk for HIV-infection, particularly in underserved, rural areas in the Deep South that are increasingly impacted by the HIV epidemic and have worse health outcomes relative to other areas in the US. The results of this work will also directly contribute to a full-scale, R01-level cluster randomized implementation trial in which we will measure the effectiveness and cost associated with a PrEP services delivery intervention serving AA women at-risk for HIV-infection in primary care and reproductive health centers in rural areas of the Deep South.

项目摘要 生活在南方腹地的非洲裔美国人（AA）妇女感染艾滋病毒的可能性是美国妇女的10倍。 白色女人。传统的艾滋病毒预防方法，包括性传播感染/艾滋病毒教育、全面的行为 干预措施和提供避孕套在这一人群中取得的成功微乎其微。HIV暴露前 PrEP已经成为一种很有前途的生物医学预防工具，其疗效超过90%， 无数的审判。PrEP有可能遏制高危妇女的艾滋病毒感染事件;然而， 美国的生物医学艾滋病预防工作通常集中在男男性行为者身上， 妇女（特别是少数种族/族裔妇女）得不到充分服务， 艾滋病毒感染问题没有得到充分解决。实施科学项目迫切需要评估 并克服这一人群对PrEP的认识、吸收、坚持和坚持的障碍。的 这项应用的目的是增加农村地区有艾滋病毒感染风险的AA妇女的PrEP摄入 南部，特别是那些在亚拉巴马农村地区的联邦合格医疗中心（FQHC）寻求护理的人。 我们将使用混合方法的方法来适应和试点测试的病人提供者的沟通工具， CDC PrEP工具包，侧重于PrEP级联的前三个步骤（例如，认识到艾滋病毒的风险， 确定为PrEP候选人，并对PrEP感兴趣），以通过转介到当地PrEP来增加PrEP吸收 诊所。具体而言，我们建议：（1）探索最近使用PrEP的AA妇女的艾滋病毒风险感知 （N=15-25），作为PrEP候选人的AA女性（N=15-25）和提供者（N=20），并确定 关于艾滋病毒风险和PrEP服务的患者-提供者沟通的偏好， AA妇女的需求;（2A）系统地调整患者-提供者沟通工具，以增加PrEP 在农村亚拉巴马的两个温室气体排放控制中心的吸收，使用迭代实施过程;和（2B）。评估 可行性，可接受性，以及对PrEP的患者-提供者沟通干预的初步影响 AA妇女及其提供者在试点前/后干预设计中的吸收（N=250）。作为目标的一部分， 2B），我们还将系统地记录和评估拒绝PrEP转诊的原因， 不完整的转诊，成功转诊后未能启动PrEP的原因，以及持续使用PrEP， 在我们的样本中，PrEP启动后3/6个月。拟议的工作将大大有助于我们 了解影响艾滋病毒感染高风险AA妇女接受和使用PrEP的因素， 特别是在服务不足的南方腹地的农村地区，这些地区越来越受到艾滋病毒流行的影响 与美国其他地区相比，健康状况更差。这项工作的结果也将直接 有助于一个全面的，R 01水平的集群随机实施试验，我们将衡量 与PrEP服务提供干预措施相关的有效性和成本，为面临以下风险的AA妇女提供服务： 南方腹地农村地区初级保健和生殖健康中心的艾滋病毒感染。