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

项目概要/摘要 在美国，艾滋病毒和性传播感染（STI）对青少年的影响不成比例， 年轻人（AYA）。13- 124岁的青年占艾滋病毒病例的21%。此外，2017年数据 性传播感染率连续第四年上升，发病率最高的是阿雅。 在这些公共卫生挑战中，2018年批准替诺福韦-恩曲他滨作为艾滋病毒预暴露 为青少年提供预防性教育（PrEP）是加强青少年艾滋病毒和性传播感染预防的重要机会 服务目前，<2%的美国PrEP处方是针对18岁以下的青少年。儿科初级保健 因此，提供者（PCP）有能力扩大PrEP的提供。然而，性健康服务的提供， 初级保健受到初级保健方案时间限制和竞争需求的阻碍。这两方面都有迫切需要 增加PrEP摄入和减少青少年性传播感染的行为干预措施，以及实施战略 在青少年初级保健中传播PrEP并加强性健康服务。K23的目标是 应用程序是为了方便博士莎拉M.伍德的长期目标是成为一名独立的调查员， 通过培训和应用研究的综合方案预防青少年艾滋病毒和性传播感染， 使她做好准备，迎接当前艾滋病毒和性传播感染流行病的挑战。这个奖项也将聚焦在她身上 短期目标是获得适应、优化实施所需的方法学专业知识， 测试，一个发展-定制，PrEP-包容性，艾滋病毒/性病预防健康辅导干预， 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业知识：1）生物行为干预适应，2）实施 科学，和3）临床试验方法。这一培训计划将得到一个高技能的指导团队的支持 具有干预发展、青少年性健康和定性方法方面的专门知识， 注重实效的临床试验。咨询小组将提供进一步的专门知识， 预防科学，实施科学，心理健康测量和目标，以及临床试验设计 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。 目标1将使用定性方法和ADAPT-ITT框架来适应健康教练干预。目的 2将确定干预措施在初级保健提供者中的可接受性和可行性，并制定一个 优化的初级保健干预实施策略。最后，目标3将进行一次小规模的 一项随机对照试验，旨在测试干预措施对预防自我保健功效的变化以及可接受性 和可行性，并在有性病史的青少年。伍德博士的研究和培训的成果将 提交R 01申请，用于I类混合随机有效性-重复实施试验， 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.