Implementation of PrEP for Women Who Inject Drugs through Practice Facilitation in Primary and Reproductive Health Care

项目概要/摘要：这项研究的目的是预防注射妇女中的艾滋病毒感染。 通过组织级改变暴露前预防（PrEP）的方式， 这个人口。Starbird博士提出了一项研究和职业发展计划，这将使她做好准备， 独立评估系统级干预措施，以改善对具有高能力的WWID的护理服务， 实施.由于不安全和不安全的双重影响，WWID是最容易感染艾滋病毒的人群之一。 注射和性行为。PrEP是有效的，并建议在高危人群中预防艾滋病毒感染 组，包括WWID。然而，WWID中的PrEP吸收滞后- 92%接受PrEP的人 在纽约州是男人。组织层面的干预措施为改善PrEP提供了机会 减少注射吸毒者中的性别差距，特别是在小学和中学， 生殖保健机构，当他们出现时，可以让WWID参与持续的PrEP使用， 并发症管理、心理社会服务或妊娠支持。包括WWID的PrEP经常 资源不足和捉襟见肘的初级保健和生殖保健环境对组织构成挑战 可以通过实践促进来消除。实践促进是一项基于证据的战略， 诊所通过技术援助、后勤支持实施PrEP等干预措施的能力， 建立外部伙伴关系。这项研究将利用NIDA在健康社区研究中的投资， 纽约州（UM 1 DA 049415，PI：El-Bassel，主要导师），以实现以下具体目标：1） 探索WWID关于如何向他们提供PrEP的意见，2）检查提供者-和组织- 水平的障碍和促进者，以提供PrEP的WWID，和3）适应和试点测试的可行性， 实践促进的可接受性，以改善初级和生殖保健中向WWID提供PrEP 设置.我们假设，PrEP实践促进将是可行的，并接受小学和 生殖保健组织，并表现出增加妇女参与性疾病比例的潜力， 获得PrEP的处方。Starbird博士有助于了解PrEP的功效，有效性和 对物质使用障碍、艾滋病毒和丙型肝炎患者进行干预的经济影响。这 指导研究科学家发展奖建立在这一经验，并通过培训在四个 关键技能：1）高级定性分析，2）组织行为变革，3）实施科学，以及 4)对弱势妇女进行道德研究。拟议的K 01将提供培训、指导和 研究经验，这将成为Starbird博士作为独立调查员的职业生涯的基础 致力于改善边缘化人群的医疗服务。该项目与 战略目标，并直接与艾滋病研究办公室的交叉领域， 健康差距和实施科学研究，以减少艾滋病毒的发病率。

PROJECT SUMMARY/ABSTRACT: The goal of this research is to prevent HIV among women who inject drugs (WWID) through organization-level change in the way pre-exposure prophylaxis (PrEP) is delivered to this population. Dr. Starbird is proposing a research and career development plan which will prepare her to independently evaluate system-level interventions to improve care delivery to WWID with high capacity for implementation. WWID are among the most vulnerable to acquiring HIV due to the dual effects of both unsafe injecting and sexual practices. PrEP is effective and recommended to prevent HIV infection among high-risk groups, including WWID. However, PrEP uptake among WWID is lagging – 92% of people who receive PrEP in New York State are men. Interventions at the organizational level present an opportunity to improve PrEP delivery and decrease gender disparities among people who inject drugs, particularly in primary and reproductive healthcare settings which can engage WWID in ongoing PrEP use when they present for comorbidity management, psychosocial services, or pregnancy support. Including PrEP for WWID in often under-resourced and stretched primary and reproductive healthcare settings poses organizational challenges that may be eliminated with Practice Facilitation. Practice Facilitation is an evidence-based strategy to support clinics' abilities to implement an intervention such as PrEP through technical assistance, logistical support, and external partnership building. This study will leverage NIDA's investment in the HEALing Communities Study in New York State (UM1 DA049415, PI: El-Bassel, primary mentor) to achieve the following specific aims: 1) explore the opinions of WWID about how PrEP is delivered to them, 2) examine the provider- and organization- level barriers and facilitators to delivering PrEP to WWID, and 3) adapt and pilot test the feasibility and acceptability of Practice Facilitation to improve PrEP delivery to WWID in primary and reproductive healthcare settings. We hypothesize that PrEP Practice Facilitation will be feasible and acceptable to primary and reproductive healthcare organizations and demonstrate potential to increase the proportion of WWID who receive a prescription for PrEP. Dr. Starbird has contributed to understanding the efficacy, effectiveness, and economic implications of interventions for individuals with substance use disorder, HIV, and hepatitis C. This Mentored Research Scientist Development Award builds on this experience and extends it with training in four key skills: 1) advanced qualitative analysis, 2) organizational behavior change, 3) implementation science, and 4) ethical conduct of research with vulnerable women. The proposed K01 will provide training, mentorship, and research experience that will serve as the foundation for Dr. Starbird's career as an independent investigator dedicated to improving healthcare delivery for marginalized populations. This project is well-aligned with the strategic objectives of NIDA and also directly in line with the Office of AIDS Research cross-cutting areas of Health Disparities and Implementation Science Research to reduce the incidence of HIV.