A differentiated care model to improve the efficiency of PrEP delivery in Kenya

项目摘要和摘要 拟议的K99/R00奖的总体目标是支持Kenneth Mugwanya博士的研究培训 发展成为独立的全球健康艾滋病毒研究人员，专注于严格执行的应用 科学研究方法将有效的艾滋病毒干预措施转化为实践。穆格万尼亚医生是一名内科医生- 流行病学家，华盛顿大学博士后研究员。这份提案勾勒出了四年的职业生涯。 发展和培训计划，以增强他在实施科学研究方面的新技能。 培训计划：为了扩展他的技能并确保过渡到独立，候选人已经组建了一个 来自美国和肯尼亚的多学科指导团队，拥有实施科学、临床试验、 艾滋病毒预防、PrEP、定性研究和影响评估。他们共同制定了一项强有力的培训 和指导计划，包括相关的高级课程、研讨会、科学会议和定期 与导师们会面。K阶段的培训目标是：1)熟练掌握基础知识 实施科学研究方法，包括业务研究、监测和评价， 定性方法和影响评估；2)学习如何将定性研究方法整合到设计中， 开展和实施艾滋病毒预防干预措施，以及3)向独立过渡，重点是 实施科学研究。这项拟议的工作建立在他的研究经验、先前的培训和长期的 长期的职业目标是为可扩展的解决方案做出贡献，以降低全球艾滋病毒发病率。 研究计划：PREP是一种有效的艾滋病毒预防策略，但最大限度地增加了获得机会，并将交付成本降至最低 是优化公共卫生影响的关键挑战。在肯尼亚，艾滋病毒疫情排名第四的国家 血清不一致的夫妇和高危妇女占新感染病例的50%。我们正在进行一场全国性的 在肯尼亚的常规诊所扩大针对夫妇和其他高危人群的预防接种计划(R01MH095507)。我们有 发现PrEP是非常理想的，但PrEP级联中的低效对最佳效率构成了挑战。这个 我们四个综合目标的总体目标是定义一个可扩展的模型，用于节省时间和成本的PrEP 条文。具体目标是：1)开发可扩展的差异化护理模式，以实现高效的PrEP交付 核心战略包括快速风险评估、艾滋病毒自我检测(HIVST)、直接到药房访问以及 2)进行一项试点随机试验，以测试差别化护理模式是否能促进 有效地提供PrEP；3)进行混合方法研究，以探索可接受性以及HIVST、药房 就诊次数和符合PrEP规定的PoC肌酐；以及4)评估差异化的成本和成本效益 PrEP的交付。这些研究目标与Mugwanya博士的培训目标一致；他将成为一个 能够为高度优先的公共卫生问题做出重大贡献的独立科学家。

PROJECT SUMMARY AND ABSTRACT The overall goal of the proposed K99/R00 Award is to support Dr. Kenneth Mugwanya’s research training to develop into an independent global health HIV researcher, focusing on application of rigorous implementation science research methods to translate effective HIV interventions to practice. Dr. Mugwanya is a physician- epidemiologist and a postdoctoral fellow at the University of Washington. This proposal outlines a 4-year career development and training plan to bolster his capacity with new skills in implementation science research. Training plan: To expand his skills and ensure transition to independence, the candidate has assembled a multidisciplinary mentoring team from the U.S. and Kenya with expertise in implementation science, clinical trials, HIV prevention, PrEP, qualitative research, and impact evaluation. Together, they have crafted a robust training and mentoring plan that includes relevant advanced coursework, seminars, scientific conferences, and regular meetings with the mentors. The training goals for the K-phase are: 1) Gain strong proficiency in the fundamentals of implementation science research methods, including operations research, monitoring and evaluation, qualitative methods, and impact evaluation; 2) Learn how to integrate qualitative research methods in the design, conduct, and implementation of HIV prevention interventions, and 3) Transition to independence with a focus on implementation science research. The proposed work builds on his research experience, prior training, and long- term career goal of contributing to scalable solutions to reduce HIV incidence globally. Research plan: PrEP is a potent HIV prevention strategy but maximizing access and minimizing costs of delivery are key challenges for optimizing the public health impact. In Kenya, the country with 4th largest epidemic, HIV serodiscordant couples and at-risk women account for >50% of new infections. We are conducting a national scale-up of PrEP for couples and other at-risk persons in routine clinics in Kenya (R01MH095507). We have found PrEP is highly desired but inefficiencies in the PrEP cascade pose a challenge to optimal efficiency. The overall goal of our four integrated aims is to define a scalable model for time-efficient and cost-saving PrEP provision. The Specific Aims are: 1) Develop a scalable differentiated care model for efficient PrEP delivery with core strategies including rapid risk assessment, HIV self-testing (HIVST), direct-to-pharmacy visits, and point – of-care (POC) creatinine; 2) Conduct a pilot randomized trial to test whether a differentiated care model promotes efficient PrEP provision; 3) Conduct a mixed methods study to explore acceptability and how HIVST, pharmacy visits, and POC creatinine fit into PrEP provision; and 4) Assess the cost and cost-effectiveness of differentiated delivery of PrEP. These research aims correspond with Dr. Mugwanya’s training goals; he will emerge as an independent scientist able to make substantial contributions to high priority public health problems.