Using Audience Segmentation to Identify Implementation Strategies to Improve PrEP Uptake Among At-Risk Cisgender Women

项目摘要 在美国，18%的新艾滋病毒感染发生在顺性妇女(顺式妇女)中，这些比率达到 然而，在美国一些地区，高达30%的符合条件的顺式妇女只有7%的人预先开过处方 预防暴露(PrEP)，以预防艾滋病毒感染。值得注意的是，艾滋病毒发病率较高的地区 顺位女性的PrEP摄取率也是这一群体中最低的。不像男人和男人发生性关系或者 跨性别女性、顺式女性更有可能从各种临床环境中寻求PrEP，包括那些专注于 更多关于性健康和生殖健康以及计划生育，例如妇产科保健实践 面向LGBT的服务。迫切需要在这一背景下发展执行PrEP的科学 为独联体妇女提供性健康和生殖健康服务。改善PrEP的有希望的实施策略 对妇女的接生包括针对组织/临床因素、提供者对PrEP作为艾滋病毒的接受度 针对顺位妇女的预防战略、提供者认为的执业范围以及顺位妇女对以下问题的了解 PrEP的具体注意事项。受众细分是一种新的方法，可以帮助理解 实施战略的这种差异，根据需求对性健康提供者进行分类，并 组织气候(受众细分)，并将这些子群体与适当的实施相匹配 增加PrEP处方的战略，以遏制高危顺位妇女的艾滋病毒感染率。 利用序贯混合方法设计，在I-PARIHS框架的指导下，本研究旨在开发 在变化性健康中匹配临床提供者的异质需求的实施策略 增加顺式妇女摄取PrEP的环境。目标1将使用定性方法(深入 约谈与有处方权力、PrEP资格的顺性女性工作的性健康提供者 顺位-妇女[顺位--正在和目前没有参加PrEP的妇女]，以及行政利益攸关方)，以确定潜在的 与性健康受众相关的临床医生特征和临床环境因素 供应商。定性结果将为目标2中使用的调查内容提供信息。目标2包括定量调查 约340名性健康提供者，使用潜在类别分析来确定关键受众群体，基于 关于提供者的响应模式，创建具有相似态度、需求和 组织氛围。利用专家提供商小组，Aim 3寻求将受众群体与菜单相匹配 适用于这些受众的特定需求和组织环境的实施战略 细分市场。拟议中的研究有可能对我们理解 针对顺位妇女寻求PrEP和PREP的变化性健康环境的适当执行战略 这项研究的结果将为未来专注于临床医生的应用提供创新的方法 旨在改善高危顺式妇女PrEP实施的医疗保健环境，这是 有效的艾滋病毒预防战略。

PROJECT ABSTRACT In the US, 18% of new HIV infections occur among cisgender women (cis-women), with these rates reaching as high as 30% in some parts of the U.S., however, only 7% of eligible cis-women have been prescribed pre- exposure prophylaxis (PrEP) for the prevention of HIV infection. Notably, areas with higher HIV incidence among cis women also have the lowest rates of PrEP uptake among this group. Unlike men who have sex with men or trans-women, cis-women are more likely to seek PrEP from a variety of clinical settings including ones that focus more on sexual and reproductive health and family planning, such as OB/GYN healthcare practices in addition to LGBT oriented services. There is a crucial need to develop the science of PrEP implementation in the context of sexual and reproductive health services for cis-women. Promising implementation strategies to improve PrEP delivery for women include targeting organizational/clinic factors, provider acceptability of PrEP as an HIV prevention strategy for cis-women, providers’ perceived scope of practice, and cis-women’s knowledge about specific considerations for PrEP. Audience segmentation is a novel approach that can assist in understanding this variability in implementation strategies, categorize sexual health providers based on their needs and organizational climates (audience segments), and to match these sub-populations to appropriate implementation strategies to increase the prescription of PrEP in order to curb HIV infection rates among at-risk cis-women. Utilizing a sequential mixed methods design and guided by the i-PARIHS framework, this study aims to develop implementation strategies that match the heterogenous needs of clinical providers in variable sexual health settings for increasing the uptake of PrEP among cis-women. Aim 1 will use qualitative methods (in-depth interviews sexual health providers working with cis-gender women who have prescriptive authority, PrEP eligible cis-women [cis-women on, and not currently on PrEP], and administrative stakeholders) to identify potential clinician characteristics and clinical environmental factors related to audience segments of sexual health providers. Qualitative findings will inform survey content to be used in Aim 2. Aim 2 includes quantitative surveys with ~340 sexual health providers, analyzed using latent class analysis to identify key audience segments based on providers’ patterns of responses, creating groups of individuals that have similar attitudes, needs, and organizational climates. Utilizing expert provider panels, Aim 3 seeks to match the audience segments to menus of implementation strategies suitable for the specific needs and organizational climates of these audience segments. The proposed study has the potential to make a significant contribution to our understanding of appropriate implementation strategies for the variable sexual health settings in which cis-women seek PrEP and the results of this study will provide innovative approaches for future applications focused on clinicians within healthcare settings designed to improve the implementation of PrEP for at-risk cis-women, a key population for effective HIV prevention strategies.