Implementation of PrEP for Women Who Inject Drugs through Practice Facilitation in Primary and Reproductive Health Care

项目摘要/摘要：这项研究的目标是预防注射艾滋病毒的妇女感染艾滋病毒 药物(WWID)通过组织级别的暴露前预防(PrEP)交付方式的变化 这群人。斯塔伯德博士正在提出一项研究和职业发展计划，这将使她做好准备 独立评估系统级干预措施，以改善对具有高容量的WWID的护理提供 实施。由于这两种不安全因素的双重影响，WWID是最容易感染艾滋病毒的人群之一 注射和性行为。PREP是有效的，建议在高危人群中预防艾滋病毒感染 组，包括WWID。然而，WWID对PrEP的接受程度落后于接受PrEP的人-92% 在纽约州都是男人。组织层面的干预措施为改进PrEP提供了机会 减少注射吸毒者中的性别差异，特别是在初级和 生殖保健设置，当WWID呈现时，可以让WWID参与持续的PrEP使用 合并症治疗、心理社会服务或怀孕支持。经常将WWID的PrEP包括在内 资源不足和捉襟见肘的初级和生殖保健环境构成了组织挑战 这可以通过练习促进来消除。实践促进是一种以证据为基础的战略，以支持 诊所通过技术援助、后勤支持和 建立外部伙伴关系。这项研究将利用NIDA在修复社区研究中的投资 纽约州(UM1 DA049415，PI：El-Bassel，Mentor)实现以下具体目标：1)探索 WWID对如何向他们交付PrEP的意见，2)检查提供商和组织级别 向WWID提供PrEP的障碍和推动者，以及3)适应和试点测试可行性和可接受性 在初级和生殖保健环境中，通过实践促进改善对WWID的PrEP交付。我们 假设PrEP练习促进将是可行的和可接受的初级和生殖 并展示了提高接受WWID的比例的潜力 PrEP的处方。斯塔伯德博士对了解这种药物的有效性、有效性和经济性做出了贡献 干预措施对药物使用障碍、艾滋病毒和丙型肝炎患者的影响 研究科学家发展奖建立在这一经验的基础上，并通过四项关键技能的培训来扩展它： 1)高级定性分析，2)组织行为改变，3)实施科学，4)伦理 开展对弱势妇女的研究。拟议的K01将提供培训、指导和研究 这些经验将成为星鸟博士作为一名独立调查员致力于 改善对边缘人群的医疗保健服务。该项目很好地与 NIDA的目标也直接与艾滋病研究办公室的卫生交叉领域保持一致 差距和实施科学研究，以减少艾滋病毒的发病率。

PROJECT SUMMARY/ABSTRACT: The goal of this research is to prevent HIV among women who inject drugs (WWID) through organization-level change in the way pre-exposure prophylaxis (PrEP) is delivered to this population. Dr. Starbird is proposing a research and career development plan which will prepare her to independently evaluate system-level interventions to improve care delivery to WWID with high capacity for implementation. WWID are among the most vulnerable to acquiring HIV due to the dual effects of both unsafe injecting and sexual practices. PrEP is effective and recommended to prevent HIV infection among high-risk groups, including WWID. However, PrEP uptake among WWID is lagging – 92% of people who receive PrEP in New York State are men. Interventions at the organizational level present an opportunity to improve PrEP delivery and decrease gender disparities among people who inject drugs, particularly in primary and reproductive healthcare settings which can engage WWID in ongoing PrEP use when they present for comorbidity management, psychosocial services, or pregnancy support. Including PrEP for WWID in often under-resourced and stretched primary and reproductive healthcare settings poses organizational challenges that may be eliminated with Practice Facilitation. Practice Facilitation is an evidence-based strategy to support clinics' abilities to implement an intervention such as PrEP through technical assistance, logistical support, and external partnership building. This study will leverage NIDA's investment in the HEALing Communities Study in New York State (UM1 DA049415, PI: El-Bassel, mentor) to achieve the following specific aims: 1) explore the opinions of WWID about how PrEP is delivered to them, 2) examine the provider- and organization-level barriers and facilitators to delivering PrEP to WWID, and 3) adapt and pilot test the feasibility and acceptability of Practice Facilitation to improve PrEP delivery to WWID in primary and reproductive healthcare settings. We hypothesize that PrEP Practice Facilitation will be feasible and acceptable to primary and reproductive healthcare organizations and demonstrate potential to increase the proportion of WWID who receive a prescription for PrEP. Dr. Starbird has contributed to understanding the efficacy, effectiveness, and economic implications of interventions for individuals with substance use disorder, HIV, and hepatitis C. This Mentored Research Scientist Development Award builds on this experience and extends it with training in four key skills: 1) advanced qualitative analysis, 2) organizational behavior change, 3) implementation science, and 4) ethical conduct of research with vulnerable women. The proposed K01 will provide training, mentorship, and research experience that will serve as the foundation for Dr. Starbird's career as an independent investigator dedicated to improving healthcare delivery for marginalized populations. This project is well-aligned with the strategic objectives of NIDA and also directly in line with the Office of AIDS Research cross-cutting areas of Health Disparities and Implementation Science Research to reduce the incidence of HIV.