Health Coaching to Improve Comprehensive HIV and Sexually Transmitted Infection Prevention in Adolescent Primary Care

项目摘要/摘要 在美国，艾滋病毒和性传播感染(STI)对青少年和 年轻人(Aya)。13-24岁的青年约占艾滋病毒病例的21%。此外，2017年的数据 性传播感染发生率连续第四年上升，发病率最高的是阿亚。 在这些公共卫生挑战中，2018年替诺福韦-恩曲他滨被批准为艾滋病毒预暴露 青少年预防(PrEP)是加强青少年艾滋病毒和性传播感染预防的关键机会 服务。目前，美国2%的预科处方是为18岁的青少年开的。儿科初级保健 因此，供应商(PCP)处于有利地位，可以扩大PrEP交付。然而，性健康服务的提供在 初级保健受到初级保健计划时间限制和相互竞争的需求的阻碍。这两者都是迫切需要的 提高青少年PrEP摄取率和减少性传播感染的行为干预措施和实施策略 在青少年初级保健中推广PrEP和增强性健康服务。这款K23的目标是 申请是为了促进Sarah M.Wood博士成为一名独立调查员的长期目标 通过综合培训和应用研究方案预防青少年艾滋病毒和性传播感染 让她做好准备，迎接当前艾滋病毒和性传播感染疫情的挑战。这一奖项也将集中在她身上 短期目标是获得适应、优化实施所需的方法专业知识，以及 TEST，一种针对发展量身定做的、包括PrEP在内的艾滋病毒/性传播感染预防健康指导干预措施 初级保健中的青少年。培训目标侧重于她目前缺乏的内容领域 实现这一目标的方法学专门知识：1)生物行为干预适应，2)实施 科学；3)临床试验方法论。这项培训计划将由一支高技能的指导团队提供支持 具有干预发展、青春期性健康和定性方法方面的专业知识，以及初级 关爱务实的临床试验。咨询团队将提供进一步的发展量身定制方面的专业知识， 预防科学、实施科学、心理健康测量和目标、临床试验设计 和分析。伍德博士的培训目标将与她的应用研究目标同步进行，并为其提供信息。 目标1将使用定性方法和适应-ITT框架来适应健康指导干预。目标 2将确定初级保健提供者对干预措施的接受度和可行性，并制定 优化初级保健干预实施策略。最后，目标3将进行一次小型的 随机对照试验，以测试干预措施对预防自我效能感的改变以及可接受性 和可行性，以及有性传播感染病史的青少年。伍德博士的研究和培训将达到顶峰 提交第一类混合随机有效性的R01申请--实施试验 健康指导干预。

PROJECT SUMMARY/ABSTRACT In the United States, HIV and sexually transmitted infections (STIs) disproportionately affect adolescents and young adults (AYA). Youth aged 13-­24 years comprise ~21% of incident HIV cases. In addition, 2017 data demonstrated the fourth consecutive year of increasing STI rates, with the highest incidence occurring in AYA. Amidst these public health challenges, the 2018 licensure of tenofovir-­emtricitabine as HIV pre-­exposure prophylaxis (PrEP) for adolescents presents a key opportunity for enhancing youth HIV and STI prevention services. Currently, <2% of U.S. PrEP prescriptions are for adolescents <18 years of age. Pediatric primary care providers (PCPs) are thus well-­positioned to expand PrEP delivery. However, sexual health service delivery in primary care is hampered by PCP time constraints and competing demands. There is a critical need for both behavioral interventions to increase PrEP uptake and reduce STIs in adolescents, and implementation strategies to disseminate PrEP and enhanced sexual health services in adolescent primary care. The goal of this K23 application is to facilitate Dr. Sarah M. Wood’s long-­term goal of becoming an independent investigator in adolescent HIV and STI prevention through an integrated program of training and applied research that will prepare her to meet the challenges of the current HIV and STI epidemics. This award will also focus on her short-­term goal of gaining the methodologic expertise needed to adapt, optimize for implementation, and test, a developmentally-­tailored, PrEP-­inclusive, HIV/STI prevention health coaching intervention for adolescents in primary care. The training objectives focus on content areas where she currently lacks the methodologic expertise to carry out this goal: 1) bio-­behavioral intervention adaptation, 2) implementation science, and 3) clinical trial methodology. This training plan will be bolstered by a highly skilled mentorship team with expertise in intervention development, adolescent sexual health and qualitative methodology, and primary care pragmatic clinical trials. The advisory team will provide further expertise in developmental tailoring, prevention science, implementation science, mental health measurement and targets, and clinical trial design and analysis. Dr. Wood’s training objectives will progress in parallel with, and inform, her applied research aims. Aim 1 will use qualitative methods and the ADAPT-­ITT framework to adapt the health coaching intervention. Aim 2 will determine acceptability and feasibility of the intervention among primary care providers, and develop an optimized primary care implementation strategy for the intervention. Finally, Aim 3 will conduct a small randomized controlled trial to test the intervention for change in prevention self-­efficacy, as well as acceptability and feasibility and in adolescents with a history of STI. The culmination of Dr. Wood’s research and training will be the submission of a R01 application for a type I hybrid randomized effectiveness-­implementation trial of the health coaching intervention.