PrEP Connect: Bridging HIV Testing to PrEP Screening and Uptake

PrEP 连接：将 HIV 检测与 PrEP 筛查和吸收联系起来

• 批准号: 10079952
• 负责人: Kathleen M MacQueen
• 金额: $ 19.7万
• 依托单位: FAMILY HEALTH INTERNATIONAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10079952
• 关键词: AIDS prevention; Agreement; Attention; Behavior; Caring; Characteristics; Cities; Client; Clinical Trials Design; Code; Communities; Counseling; County; Data; Data Analyses; Data Collection; Deception; Development; Discrimination; Economics; Educational Intervention; Effectiveness of Interventions; Elements; Environment; Epidemic; Equilibrium; Evaluation; Event; Exercise; Frequencies; Funding; Goals; HIV; HIV/STD; Health; Healthcare; High Risk Woman; Human immunodeficiency virus test; Insurance; Intake; Intervention; Interview; Mediation; Medical; Methods; Minority Access; North Carolina; Patients; Population; Prevention; Procedures; Process; Provider; Reporting; Research; Resources; Role; Service provision; Services; Sexual Health; Sexual and Gender Minorities; Structure; Surveys; Techniques; Testing; Time; Training; Visualization; Walking; base; data collection site; effectiveness evaluation; empowerment; experience; health care availability; high risk; improved; innovation; interest; men; men who have sex with men; pre-exposure prophylaxis; prevention service; racial discrimination; recruit; research clinical testing; screening; service delivery; social stigma; standard of care; transgender women; transmission process; uptake

PROJECT SUMMARY This proposal responds to PA-19-050 Engaging Men in HIV Testing, Prevention, and Care and to NOT-MD-19- 001 Notice of Special Interest in Research on the Health of Sexual and Gender Minority (SGM) Populations. HIV testing is an essential first step in reducing HIV transmission rates, but the prevention counseling component has been significantly reduced in recent years and has not incorporated validated PrEP referral processes as standard of care. For those most in need of prevention services additional barriers include the cumulative impact of experiences of racial discrimination and social stigma against SGMs compounded with persistent HIV stigma. The impact of these forces on HIV testing and prevention are widely acknowledged but remain extremely difficult to intervene upon. This exploratory study combines an innovative participatory approach and intersectional stigma framework to understand how black SGM in a Southern city experience HIV/STI testing and PrEP referral. We build on existing simulated client/patient approaches to elicit, observe, and interpret interactional behaviors in health settings to capture black SGM experiences in close to real time and proximity to the environments where they receive testing and PrEP services. The goal is to understand the subjective experience of the simulated client/patient, not conduct an objective evaluation of the provider. In Aim 1 we will (a) recruit and train eight black SGM to perform in the role of a simulated client/patient accessing HIV/STI testing and PrEP services and (b) conduct simulated walk-through exercises with providers to document and describe their standard mode of service delivery and negotiate agreements for how simulated clients/patients will access their services. In Aim 2 simulated clients/patients will complete structured surveys immediately before and after each engagement with a provider (n=32 events) followed by a qualitative de-brief interview. We will then conduct in-depth interviews with providers to understand their perspectives on the types of experiences reported. Qualitative coding and structured survey data will be combined using a matrix-based applied thematic analysis approach, including use of frequency tables and visualization techniques to compare and contrast black SGM intersectional experiences of stigma, discrimination, empowerment, and confirmation. Aim 3 centers on participatory intervention mapping with stakeholders including black SGM and providers to review the range of prevention experiences and collaboratively identify ways to improve (a) the referral/intake experience, (b) the capacity of providers to identify clients likely to benefit from PrEP, and (c) linkage to and uptake of PrEP by clients at highest risk. Findings will be of immediate value for local quality improvement in services, inform the expansion of HIV prevention services more broadly in North Carolina, and inform development of an equity-based provider training intervention to reduce experiences of intersectional stigma for black SGM accessing HIV prevention services.

项目概要 该提案回应 PA-19-050 ​​让男性参与艾滋病毒检测、预防和护理以及 NOT-MD-19- 001 对性和性别少数群体 (SGM) 人群健康研究特别感兴趣的通知。 HIV 检测是降低 HIV 传播率的重要第一步，但预防咨询 近年来，该部分已显着减少，并且未纳入经过验证的 PrEP 转诊 流程作为护理标准。对于那些最需要预防服务的人来说，额外的障碍包括 种族歧视经历和社会耻辱对 SGM 的累积影响加上 持续存在的艾滋病毒耻辱。这些力量对艾滋病毒检测和预防的影响已得到广泛认可，但 仍然极难干预。这项探索性研究结合了创新的参与性研究 方法和交叉耻辱框架，以了解黑人 SGM 在南方城市的体验 HIV/STI 检测和 PrEP 转诊。我们以现有的模拟客户/患者方法为基础来引发、观察、 并解释健康环境中的互动行为，以近乎实时地捕捉黑人 SGM 体验 以及靠近接受测试和 PrEP 服务的环境。目标是了解 模拟客户/患者的主观体验，而不是对提供者进行客观评估。瞄准 1 我们将 (a) 招募并培训八名黑人 SGM 来扮演模拟客户/患者访问的角色 HIV/STI 检测和 PrEP 服务，以及 (b) 与提供者一起进行模拟演练练习，以 记录并描述他们的标准服务交付模式，并协商如何模拟的协议 客户/患者将获得他们的服务。在目标 2 中，模拟客户/患者将完成结构化调查 每次与提供商接触之前和之后（n=32 次事件），然后进行定性汇报 面试。然后，我们将与提供商进行深入访谈，以了解他们对类型的看法 报告的经验。定性编码和结构化调查数据将使用基于矩阵的 应用主题分析方法，包括使用频率表和可视化技术进行比较 并对比黑人 SGM 在耻辱、歧视、赋权和确认方面的交叉经历。 目标 3 的重点是与利益相关者（包括黑人 SGM 和提供者）进行参与性干预映射，以 审查预防经验的范围，并共同确定改进的方法 (a) 转诊/接收 经验，(b) 提供者识别可能受益于 PrEP 的客户的能力，以及 (c) 与 风险最高的客户接受 PrEP。研究结果将对当地质量改善具有直接价值 服务，告知在北卡罗来纳州更广泛地扩大艾滋病毒预防服务，并告知 制定基于公平的提供者培训干预措施，以减少交叉耻辱的经历 帮助黑人 SGM 获得艾滋病毒预防服务。