Adaptation of a PrEP Shared-Decision Making Tool for Family Planning Clinics

计划生育诊所 PrEP 共享决策工具的改编

• 批准号: 10613804
• 负责人: Katherine M Anderson
• 金额: $ 4.77万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10613804
• 关键词: AIDS prevention; Address; Adherence; Adult; Area; Awareness; Behavioral; Belief; Black race; Caliber; Caring; Child; Client; Clinic; Clinical; Communication; Counseling; County; Decision Making; Development; Environment; Epidemic; Evaluation; Family Planning; Female; Focus Groups; Fumarates; Funding; Future; Goals; Grant; HIV; HIV Infections; HIV diagnosis; HIV risk; Health Personnel; Healthcare; Heterosexuals; Information Dissemination; Injectable; Intervention; Interview; Knowledge; Latinx; Measurement; Medical; Mentors; Mentorship; Method Acceptability; Methodology; Methods; Modality; Modeling; National Institute of Mental Health; Oral; Organizational Decision Making; Pathway interactions; Patient Preferences; Patients; Physician' s Role; Populations at Risk; Postdoctoral Fellow; Prevention; Prevention Research; Process; Provider; Quality of life; Regimen; Research; Research Personnel; Resources; Risk; Risk Factors; Sales; Services; Sexual Health; Side; Strategic Planning; Techniques; Tenofovir; Testing; Training; Training Support; Trauma; United States National Institutes of Health; Universities; Woman; Women' s Health; Work; World Health Organization; acceptability and feasibility; anxiety reduction; career; cis-female; cisgender; effectiveness/implementation trial; empowerment; emtricitabine; ethnic diversity; evidence base; experience; feasibility testing; human centered design; implementation facilitators; implementation science; improved; infection rate; interest; male; medication compliance; novel; patient-level barriers; pilot test; pre-exposure prophylaxis; preference; prevention practice; prevention service; provider-level barriers; racial diversity; research and development; satisfaction; scaffold; shared decision making; skills; social stigma; tool; training opportunity; transmission process; uptake; willingness; women of color

PROJECT SUMMARY/ABSTRACT Cisgender women account for ~20% of new HIV infections in the US, and are systematically under-accessed for HIV prevention. The intersection of patient-side barriers (lack of patient knowledge, perceived risk, and medical mistrust), and provider-side barriers (lack of knowledge, discomfort with prevention counseling, and bias) impacts uptake of novel HIV prevention methods, such as available and forthcoming methods of pre-ex- posure prophylaxis (PrEP) for HIV (oral, injectable, etc.). To address these barriers, the trainee (Ms. Anderson) will adapt a family planning (FP) shared decision-making (SDM) tool for use in HIV prevention counseling. SDM involves introducing choice, describing options, and exploring patient preferences to aid in health care decisions, while empowering women, decreasing provider bias, increasing satisfaction with care, and increas- ing adherence to care regimens. The adapted tool will be tested for acceptability/feasibility with providers and clients at Title X federally-funded FP clinics, a high-reach setting for women at risk for HIV from heterosexual contact. Guided by the ADAPT-ITT framework for adaptation, the specific aims are to (1) assess the utility of SDM practices for HIV prevention and barriers/facilitators to implementation, through (a) focus groups with Title X providers in Metro Atlanta (K=4, N=32) and (b) theater testing interviews with racially/ethnically diverse cis- gender adult Title X clients (N=40); (2) adapt the evidence-based World Health Organization (WHO) Decision- Making Tool for FP Clients and Providers for HIV prevention; and, (3) conduct mixed-method acceptability/fea- sibility testing of the adapted SDM tool with Title X providers (N=40) and clients (N=40). This study will result in an acceptable and feasible HIV prevention SDM tool for use with cisgender women attending FP clinics, to be further tested and disseminated to promote HIV prevention among women, advancing efforts to end the HIV epidemic. Additionally, this work will support the training of Ms. Anderson, who is committed to becoming a high caliber, NIH-funded researcher in HIV prevention and treatment, and improvement of care interactions. Ms. Anderson’s 3-year training plan includes: (1) formally developing methodological skills in implementation science and human-centered design, (2) advancing understanding of the context of clinical HIV prevention, including biomedical prevention and clinical interactions, and (3) developing skills in the areas of measurement and evaluation of interventions and interventional pathways. The team of mentors, Drs. Sales (Primary Spon- sor), Sheth (Co-Sponsor), and Kottke (Expert Advisor), will provide oversight, guidance, and mentorship to Ms. Anderson during the course of her training, in the topic areas of implementation science, HIV prevention, clini- cal interactions, and intervention evaluation. Ms. Anderson will leverage resources at Emory University, includ- ing the Network for Evaluation and Implementation Sciences, the Network for Evaluation and Implementation Science, the Women and Children’s Center, and the Prevention Research Center. The candidate, mentorship team, and the environment are extremely well situated to achieve the proposed research and training aims.

项目摘要/摘要 美国新增艾滋病毒感染者中，约有20%是顺性女性，而且她们系统性地得不到充分的接触 用于预防艾滋病毒。患者方障碍的交集(缺乏患者知识、感知风险和 医疗不信任)，以及提供者方面的障碍(缺乏知识，对预防咨询感到不适，以及 偏见)影响对新的艾滋病毒预防方法的接受，例如现有和即将采用的产前检查方法。 艾滋病毒的预防(PrEP)(口服、注射等)。为了解决这些障碍，实习生(安德森女士) 将采用计划生育(FP)共享决策(SDM)工具，用于艾滋病毒预防咨询。 SDM包括引入选择、描述选项和探索患者偏好以帮助医疗保健 决策，同时赋予女性权力，减少提供者偏见，提高对护理的满意度，并增加- 坚持护理养生法。调整后的工具将接受供应商的可接受性/可行性测试，并 由联邦政府资助的计划生育诊所的客户，这是一个为异性恋感染艾滋病毒风险较高的女性提供的高覆盖环境 联系。在适应-ITT适应框架的指导下，具体目标是：(1)评估 艾滋病毒预防的可持续发展管理做法和实施的障碍/促进者，通过(A)有标题的重点小组 亚特兰大大都会的X个提供商(K=4，N=32)和(B)对不同种族/民族的CI进行的剧院测试访谈- 性别成人头衔X客户(N=40)；(2)调整世界卫生组织(世卫组织)循证决定-- 为计划生育服务对象和提供者制作艾滋病毒预防工具；以及，(3)进行混合方法可接受性/有限元分析- 对修改后的SDM工具与标题X提供商(N=40)和客户(N=40)进行可行性测试。这项研究将导致 一个可接受和可行的艾滋病毒预防SDM工具，用于在计划生育诊所就诊的顺性女性，将是 进一步检测和传播，以促进在妇女中预防艾滋病毒，推动结束艾滋病毒的努力 流行病。此外，这项工作将支持安德森女士的培训，她致力于成为一名 由美国国立卫生研究院资助的高素质艾滋病毒预防和治疗研究人员，以及改善护理互动。 安德森女士的三年培训计划包括：(1)正式发展实施中的方法技能 科学和以人为本的设计，(2)增进对临床艾滋病毒预防背景的理解， 包括生物医学预防和临床相互作用，以及(3)发展测量领域的技能 以及干预措施和干预途径的评估。导师团队，销售博士(初级Spon- Sor)、Sheth(共同赞助商)和Kottke(专家顾问)将向她提供监督、指导和指导。 安德森在她的培训过程中，在实施科学、艾滋病毒预防、临床- CAL交互作用和干预评估。安德森女士将利用埃默里大学的资源，包括- 评价和实施科学网络，评价和实施网络 科学、妇女和儿童中心以及预防研究中心。候选人，导师制 团队和环境都处于非常有利的位置，可以实现拟议的研究和培训目标。