DiversiPrEP: Multi-Level Variables Influencing Implementation Success of a Client-Centered PrEP Service Model with Telehealth

项目摘要 这项为期一年的补充提案是由迈阿密大学医学院制定的， 心理学和拉丁美洲人健康-一个由HRSA资助的病例管理，测试和预防机构， 提供暴露前预防（PrEP）服务的诊所。这个实施科学项目的目标是 是了解可改变的因素以及从业人员和支持人员、客户和利益相关者的行为 影响采用和实施多样化的PrEP，这是一个针对拉丁美洲人的文化定制的PrEP计划。 DiversiPrEP使用以客户为中心的服务模式（包括亲自和远程医疗）来推进常规艾滋病毒 测试和提供PrEP。多样化PrEP帮助拉丁美洲人了解PrEP，决定PrEP是否与他们的生活相关， 浏览健康保险或患者援助计划，访问PrEP并持续使用PrEP。DiversiPrEP是 在所有四个拉丁美洲健康的网站位于布劳沃德和迈阿密戴德县提供-共同的 美国艾滋病发病率和流行率最高的县。为了实现跨站点协作，我们 从实施变革的专家建议（ERIC）项目中选择了五项战略。这些 利益攸关方系统地编制了战略，以确保标准化（增加需求， 提高适应性，改变客户费用，与客户进行干预，以提高吸收和坚持，并量身定制 战略）。我们的目标是由实现科学框架指导，以确定可测试的机制 影响实施的成功，有助于扩大由HRSA资助的诊所提供的PrEP服务， 并推进实施科学。目标1.与工作人员进行的混合方法访谈将确定 实施科学研究框架（CFIR）解释实施的可修改因素 在拉丁美洲健康网站所在的四个地理区域的多样化准备。每个区域的特点是 一个大的亚群的存在：迈阿密海滩（游客），西南迈阿密（大学生）， 宅基地（季节性农场工人）和布劳沃德（中年男子与男子发生性关系-MSM）。我们将 还按客户群（拉丁裔男男性接触者、非拉丁裔男男性接触者、顺性别女性和 transgender人）using使用photovoice照片. Photovoice是一种使用照片和叙述的技术， 为参与者提供了一个安全的空间，让他们分享故事，恐惧，担忧和希望， 制备型目标2.我们将通过基于证据的质量改进来完善ERIC实施策略 （EBQI）与临床医生、管理人员、一线工作人员、利益相关者和实施科学的流程 专家目标3.我们将评估DiversiPrEP的覆盖范围（PrEP向高危人群提供的程度） 使用RE-AIM的实施（按设计交付多样化PrEP的程度）。产品：1） 一个逻辑模型来构造和优先化特定的实现结构。2)操作手册和同行 审查出版物，总结经验教训，并制定一个程序， 实施战略，以支持大规模提供PrEP服务，并在其他HRSA资助的为拉丁美洲人服务的诊所提供PrEP服务。

PROJECT SUMMARY This one-year supplement proposal was developed by University of Miami Schools of Medicine and Psychology, and Latinos Salud—a HRSA-funded case management, testing and prevention agency with a clinic that provides Pre-Exposure Prophylaxis (PrEP) services. The goal of this implementation science project is to understand modifiable factors and the behavior of practitioners and support staff, clients, and stakeholders influencing the adoption and implementation of DiversiPrEP, a culturally tailored PrEP program for Latinos. DiversiPrEP uses a client-centered service model (both in person and with telehealth) to advance routine HIV testing and deliver PrEP. DiversiPrEP helps Latinos learn about PrEP, decide if PrEP is relevant for their lives, navigate health insurance or patient assistance programs, access PrEP, and sustain PrEP use. DiversiPrEP is offered at all four of Latinos Salud’s sites located in Broward and Miami-Dade counties—collectively the counties with the highest HIV incidence and prevalence in the US. To enable cross-site collaboration, we selected five strategies from the Expert Recommendations for Implementing Change (ERIC) project. These strategies were systematically compiled by stakeholders to ensure standardization (Increase Demand, Promote Adaptability, Alter Client Fees, Intervene with Clients to Enhance Uptake and Adherence, and Tailor Strategies). Our Aims are guided by implementation science frameworks to identify testable mechanisms influencing implementation success, contribute to expanding PrEP services provided by HRSA-funded clinics, and advance implementation science. Aim 1. Mixed methods interviews with staff will identify Consolidated Framework for Implementation Science Research (CFIR) modifiable factors that explain the implementation of DiversiPrEP in the four geographic areas where Latinos Salud sites are located. Each area is characterized by the presence of a large sub-population: Miami Beach (tourists), Southwest Miami (university students), Homestead (seasonal farmworkers) and Broward (middle aged men who have sex with men-MSM). We will also identify CFIR modifiable factors by clientele group (Latino MSM, non-Latino MSM, cisgender female and transgender people) using photovoice. Photovoice is a technique that uses photos and narratives, and provides a safe space for participants to share stories, fears, concerns, and hopes for accessing and using PrEP. Aim 2. We will refine ERIC implementation strategies through an Evidence Based Quality Improvement (EBQI) process with clinicians, administrators, front line staff, stakeholders and implementation science experts. Aim 3. We will evaluate DiversiPrEP’s Reach (the extent to which PrEP is delivered to at-risk persons) and Implementation (the extent to which DiversiPrEP is delivered as designed) using RE-AIM. Deliverables: 1) a logic model to structure and prioritize specific implementation constructs. 2) An operational manual and peer reviewed publications to summarize lessons learned and formulate a process for developing DiversiPrEP’s implementation strategies to support PrEP delivery at scale and in other HRSA-funded clinics serving Latinos.