Training in implementation science research to improve PrEP services for people at risk for HIV

项目总结/摘要 艾滋病毒护理和预防的有效管理战略是存在的，但许多基于证据的 诸如暴露前预防（PrEP）等干预措施没有充分推广到实践中， 那些最需要的人。实施科学（IS）旨在弥合研究与实践之间的差距， 确保循证干预措施大规模得到有效落实。信息系统方法正在迅速发展; 学员需要有专门的时间和研究平台的导师，提供学习和应用信息系统的机会 方法，因为他们对独立的研究事业的工作。Sheri Lippman博士，助理 在加州大学旧金山分校的驻地教授，建议：1）扩大她的辅导计划，包括正式培训， 获得指导能力，以提高她提供的早期职业生涯培训的呼吸和深度 科学家; 2）扩大她自己的计划，从事信息系统研究，重点是提高 通过解决诊所和卫生系统的障碍，向服务不足的人群提供PrEP 照顾;和3）提供早期职业科学家在加州大学旧金山分校的计划和合作研究机构在国外 with a platform平台to train训练in IS方法.李普曼博士建立了一个研究组合，专注于社会行为 制定干预措施，支持个人和动员社区接受艾滋病毒检测、预防， 和护理，主要是在巴西和南非。本K24中以患者为导向的研究包括探索 实施研究综合框架（CFIR）的上下文域，以表征 巴西圣保罗为变性妇女提供服务的诊所的PrEP提供情况， 在南非阿金库尔的少女和青年妇女协会（目标1）。这项工作包括 利益攸关方参与的进程，以达成一套拟议的实施战略，以改善PrEP 根据专家的分类法提供服务，促进PrEP的吸收和维护 实施变革项目的建议（目标2）。最后，战略将在一个 在每个研究中心设立诊所，评估可行性、可接受性和监测过程，为更大规模的试验做准备 （R 01）评估所选策略是否改善PrEP的提供，摄取和维持。的 研究的重点是为巴西的TGW和南非的AGYW提供PrEP，因为这两个群体都是 艾滋病毒发病率高，对艾滋病毒护理的参与度低，尽管表示有兴趣使用PrEP，但PrEP的使用率低。 博士Lippman在这两个领域都有广泛的合作，包括NIH支持的工作， 在美国的早期职业调查人员中，有大量的指导和激励新研究的机会 和两国。总之，K24为Lippman博士提供了一个机会，可以扩展她的IS研究， 通过实施消除诊所和卫生系统环境中PrEP提供的障碍 为每个站点量身定制的策略，同时建立她的指导计划，以确保 研究人员的技能，以建立新的职业生涯和科学调查的新兴领域的信息系统。

PROJECT SUMMARY/ABSTRACT Strategies for effective management of HIV care and prevention exist, however many evidence-based interventions, such as Pre-exposure prophylaxis (PrEP), are not sufficiently scaled into practice, failing to reach those most in need. Implementation science (IS) seeks to bridge the gap between research and practice to ensure that evidence-based interventions are translated effectively at scale. IS methods are rapidly evolving; trainees require mentors with dedicated time and research platforms to offer opportunities to learn and apply IS methods as they work towards independent research careers. In this proposal Dr. Sheri Lippman, Associate Professor in Residence at UCSF, proposes to: 1) expand her mentoring program, including formal training to attain mentoring competencies, to improve the breathe and depth of the training she offers early career scientists; 2) expand her own program of stakeholder-engaged IS research focused on means to improving PrEP delivery to populations who are underserved through addressing clinic- and health system-based barriers to care; and 3) provide early career scientists in UCSF programs and collaborating research institutions abroad with a platform to train in IS methods. Dr. Lippman has built a research portfolio focused on social-behavioral intervention development, supporting individuals and mobilizing communities to uptake HIV testing, prevention, and care, mostly in Brazil and South Africa. The patient-oriented research in this K24 includes exploring contextual domains from the Consolidated Framework for Implementation Research (CFIR) to characterize the PrEP delivery context in clinics attending transgender women (TGW) in São Paulo, Brazil, and clinics attending adolescent girls and young women (AGYW) in Agincourt, South Africa (Aim 1). The work then includes stakeholder engaged processes to arrive at a proposed set of implementation strategies to improve PrEP service delivery that facilitates PrEP uptake and maintenance based on the taxonomies from the Expert Recommendations for Implementing Change (ERIC) Project (Aim 2). Finally, strategies will be piloted at one clinic in each site to assess feasibility, acceptability, and monitoring processes to prepare for larger trials (R01s) that evaluate whether selected strategies improve PrEP delivery, uptake, and maintenance. The research focuses on PrEP delivery for TGW in Brazil and AGYW in South Africa as both are populations who have high HIV incidence, poor engagement in HIV care, and low uptake of PrEP despite stated interest in use. Dr. Lippman has extensive collaborations, including NIH-supported work, in both areas and can ensure abundant opportunities for mentoring and stimulating new research among early career investigators in the US and both countries. In sum, this K24 provides an opportunity for Dr. Lippman to expand her IS research to address barriers to PrEP delivery in the clinic and health-system environment through implementation strategies tailored to each site, concurrently building her mentoring program to ensure a pipeline of investigators with skills to establish new careers and scientific inquiry in the burgeoning field of IS.