Using Coincidence Analysis to Investigate Factors Affecting PrEP Initiation and Continuation in Southern ending the Epidemic Counties

利用巧合分析探讨影响南方疫情结束县PrEP启动和持续的因素

• 批准号: 10601235
• 负责人: Trace S Kershaw
• 金额: $ 36.41万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-30 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10601235
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Advocacy; Affect; Black race; Caring; Client; Clinical; Communities; Consolidated Framework for Implementation Research; County; Data; Data Aggregation; Ensure; Epidemic; Florida; Goals; Guidelines; HIV; Health Policy; Individual; Injections; Interview; Lead; Measures; Methods; Modeling; Nurses; Outcome; Outcome Study; Persons; Phase; Policies; Population; Prevention; Public Health; Research; Risk; Role; Running; Site; Structure; Surveys; System; Texas; Variant; Woman; Work; Youth; base; clinical research site; contextual factors; health care quality; health equity; implementation outcomes; implementation research; implementation strategy; improved; interest; lens; member; men who have sex with men; novel; people of color; pill; pre-exposure prophylaxis; programs; response; uptake

Project Summary Since 2012, pre-exposure prophylaxis (PrEP), typically delivered as a daily pill or more recently as a bimonthly injection, has been available as a method of HIV prevention. Despite PrEP being highly effective at reducing a person’s risk of acquiring HIV, uptake of the prevention method has been low – especially in the Southern US, which is already disproportionately impacted by HIV. In this study we will examine existing programs implementing PrEP and assess which implementation strategies and contextual factors lead to the best rates of PrEP initiation and persistence; these findings will contribute to improving PrEP delivery and the ongoing Ending the HIV Epidemic efforts in the south. The study contains two aims: Aim 1) Identify the implementation strategies and contextual factors affecting PrEP implementation within clinical and community-based organizations in southern EHE counties and Aim 2) Determine the combination(s) of implementation strategies and contextual factors that produce the most effective delivery of PrEP to populations at greatest risk of HIV acquisition. To achieve Aim 1 we will collect and summarize data through three phases. In Phase 1 we will request aggregate data from organizations that conduct HIV prevention and PrEP-related activities in Hillsborough, Pinellas, Tarrant, and Dallas Counties to measure the study outcomes (i.e., the proportions of eligible individuals who start PrEP and who have maintained PrEP use over 3-month and 6-month periods) and identify preliminary variation in the implementation strategies and site-level contextual factors that may affect PrEP implementation. In Phase 2 we will conduct quantitative surveys with staff members at a subset of sites to assess the impact of CFIR factors and presence or absence of implementation strategies on PrEP implementation outcomes. In Phase 3 we will complete semi-structured interviews to gain a more detailed and nuanced understanding of implementation strategies, contextual factors and within-site variation from Phase 2 responses. To achieve Aim 2 we will conduct Coincidence Analysis (CNA) to determine the sets of implementation strategies and contextual factors leading to high proportions of eligible individuals who both start and maintain PrEP (i.e., optimized implementation). CNA is a method of causal inference and determines the combinations of factors that are minimally necessary or sufficient for an outcome of interest. In this application we will examine which combinations of contextual factors and implementation strategies result in optimized PrEP implementation. The models will be run for three outcomes based on the following: proportion of clients who initiate PrEP; and proportion of clients continuing PrEP use after 3 and 6 months, each of which will either be dichotomized (high vs. low) or trichotomized (high, medium, low). Additional factors, representing differences in client populations (e.g., MSM, women, youth) will be included in the analyses to determine whether unique sets of strategies and factors lead to optimization for different populations.

项目摘要 自2012年以来，暴露前预防（PrEP），通常作为每日药丸或最近作为双月一次 注射，已被用作预防艾滋病毒的一种方法。尽管PrEP在减少 人感染艾滋病毒的风险，预防方法的吸收率一直很低-特别是在美国南部， 已经不成比例地受到艾滋病毒的影响。在这项研究中，我们将审查现有的方案， 实施PrEP并评估哪些实施策略和背景因素导致最佳比率 的PrEP启动和持久性;这些研究结果将有助于改善PrEP交付和正在进行的 结束南部艾滋病毒流行病防治工作。本研究包含两个目标：目标1）确定实施情况 影响PrEP在临床和社区实施的策略和背景因素 目标2）确定实施战略的组合 和背景因素，使PrEP最有效地提供给艾滋病毒风险最高的人群 采集为了实现目标1，我们将通过三个阶段收集和总结数据。在第一阶段，我们将 要求在下列地区开展艾滋病毒预防和PrEP相关活动的组织提供汇总数据： 希尔斯伯勒、皮内拉斯、塔兰特和达拉斯县，以衡量研究结果（即，的比例 开始PrEP并在3个月和6个月期间维持PrEP使用的合格个人），以及 确定实施战略的初步变化和可能影响的现场层面的背景因素 PrEP实施。在第2阶段，我们将在一部分研究中心对工作人员进行定量调查 评估CFIR因素的影响以及是否存在PrEP实施策略 执行成果。在第三阶段，我们将完成半结构化面试，以获得更详细， 对第2阶段的实施策略、背景因素和研究中心内差异有细致入微的理解 应答为了实现目标2，我们将进行重合分析（CNA），以确定 实施战略和背景因素，导致符合条件的个人中， 启动和维持PrEP（即，优化实现）。CNA是一种因果推理方法， 对于所关注的结果而言，最低限度必要或足够的因素组合。在这 应用程序，我们将研究哪些上下文因素和实施策略的组合导致 优化PrEP实施。模型将根据以下三个结果运行： 启动PrEP的客户比例;以及在3个月和6个月后继续使用PrEP的客户比例，其中每个 将被二分（高与低）或二分（高、中、低）。其他因素，代表 客户群体的差异（例如，男男性行为者、妇女、青年）将被纳入分析，以确定 不同的策略和因素是否会导致不同群体的优化。