An Interactive Systems Approach to Ending the HIV Epidemic Among Women in Atlanta

摘要 供需限制影响了美国南部顺性女性PrEP的扩大。准备 使用要求确保可受益于PrEP的顺性妇女意识到这一点(即，需求方)和 确保在顺性妇女寻求护理的环境中(即，供应方)可以获得PrEP。锚定PrEP 关注由X资助的计划生育服务，这些服务是顺性别女性已经信任、经常获得并认为 对他们的性健康有很大的吸引力，因为它提供了一个理想的机会，接触到可能 受益于PrEP。在艾滋病毒新诊断率最高的州佐治亚州，我们的工作表明 许多第十条计划生育诊所不提供PrEP。我们的研究还显示，预感知度较低 并在亚特兰大顺性女性中使用。此外，我们位于亚特兰大的以计划生育为重点的PrEP 实施研究表明，即使计划生育诊所提供PrEP，也很少有顺性女性接受PrEP， 提供者注意到，对PrEP的筛查、推荐和咨询仍然感到不适。教训 从HPV疫苗和避孕推广中了解到的情况表明，仅意识和可获得性就可能 仅仅是不够的；将顺性女性从PrEP意识转移到接受需要替代分娩 包括妇女观点在内的其他模式，以克服阻碍妇女使用PrEP的其他因素。 因此，提高顺性女性的PrEP覆盖面可能需要更有效地让她们参与 发展适当和可接受的以患者为中心的PrEP护理方法，以支持摄取。在 建议的项目，我们将(目标1)使用互动系统框架来采用量身定做的实施 为支持在整个亚特兰大采用和实施PrEP所做的大量前期工作为战略提供了依据 第十章诊所(解决供应方面的障碍)；(目标2)使用循证社区组织 在顺性妇女中提高对PrEP的认识、兴趣和联系的方法(满足需求- 侧面障碍)；以及(目标3)创新地使用以患者为中心的设计(HCD)方法 这将最终用户和开发商聚集在一起，共同创建护理交付战略，使Southern 将妇女的声音纳入PrEP护理提供战略的制定。鉴于关于以下方面的研究有限 在南方顺性妇女中扩大PrEP覆盖面的战略，每个目标的结果都将 独立填补众多空白，优化诊所和社区战略，加强艾滋病毒预防 为南方女人准备的。鉴于我们与佐治亚州计划生育系统(佐治亚州第十章受赠人)的合作， 亚特兰大地区X区诊所，以及与性健康CBO(由SisterLove领导)建立牢固的合作伙伴关系，我们是 独特的定位，可以在围绕我们诊所建立的不同亚特兰大县之间建立协调的方法- 学术-CBO合作，加强妇女艾滋病毒预防，重要的是，创建一个可持续的 系统方法，更快地将新的艾滋病毒预防(和性健康)创新推广到妇女身上。

ABSTRACT Supply and demand constraints have affected PrEP scale-up for cisgender women in the Southern US. PrEP use requires ensuring that cisgender women who can benefit from PrEP are aware of it (i.e., demand side) and ensuring PrEP is accessible in settings where cisgender women seek care (i.e., supply side). Anchoring PrEP care to Title X-funded family planning services that cisgender women already trust, access routinely, and deem useful for their sexual health is of great appeal, as it offers an ideal opportunity to reach women who may benefit from PrEP. In Georgia, the state with the highest rate of new HIV diagnoses, our work demonstrates that many Title X family planning clinics do not provide PrEP. Our research also shows low PrEP awareness and use among Atlanta cisgender women. Further, our Atlanta-based family planning-focused PrEP implementation research indicates that even when FP clinics offer PrEP, few cisgender women uptake PrEP, and providers note continued discomfort with screening, recommending and counseling about PrEP. Lessons learned from HPV vaccine and contraception rollout demonstrates that awareness and availability alone may not be sufficient; moving cisgender women from PrEP awareness to uptake demands alternative delivery models, inclusive of women's perspectives, to overcome other factors impeding women from using PrEP. Improving PrEP reach among cisgender women may therefore require more effectively engaging them in the development of appropriated and acceptable patient-centered PrEP care approaches to support uptake. In the proposed project, we will (Aim 1) use the Interactive Systems Framework to employ tailored implementation strategies informed by our extensive prior work to support PrEP adoption and implementation across Atlanta Title X clinics (addressing supply-side barriers); (Aim 2) use an evidence-based Community Organizing Approach to raise awareness, interest, and connection to PrEP among cisgender women (addressing demand- side barriers); and (Aim 3) innovatively use human centered design (HCD), a patient-centered methodology that brings bringing end-users and developers together to co-create care delivery strategies, to bring Southern women's voices into the development of PrEP care delivery strategies. Given limited research pertaining to strategies to increase PrEP reach among cisgender women in the South, findings from each aim will independently fill numerous gaps for optimizing clinic and community strategies to strengthen HIV prevention for Southern women. Given our collaboration with Georgia Family Planning System (Georgia's Title X grantee), Atlanta area Title X clinics, and robust partnerships with sexual health CBOs (led by SisterLove), we are uniquely positioned to mount a coordinated approach across diverse Atlanta counties built around our clinic- academic-CBO collaboration to strengthen HIV prevention for women, and importantly, to create a sustainable systems approach to move new HIV prevention (and sexual health) innovations more quickly to women.