Centering Those Engaged in Transactional Sex: A PrEP Innovation for Getting To Zero

到2030年实现艾滋病毒新感染为零（GTZ）是公共卫生优先事项。加强艾滋病毒预防，自我- 管理和减少风险人群的危害至关重要。性工作者的艾滋病毒感染率为12 比一般人口高出一倍，这突出表明需要开展有针对性的预防工作。增加 在这一人群中最佳使用暴露前预防（PrEP）将推动GTZ 2030的进展。 社区赋权干预措施降低了性工作者中的艾滋病毒风险，因为干预措施 由目标人群共同设计、实施和评估。社区授权的PrEP 导航方法可能是可行的，性工作者可以接受。其中一种方法是一组 一种名为中心医疗保健（Centering Healthcare）的医疗保健模式，起源于一种小组产前护理模式 并且已经针对各种患者群体进行了修改。中心的三个核心组成部分：医疗保健， 交互式学习和社区建设，通过创建一个 尊重和协作的互动学习环境，尊重群体的需求。模型是阳性的 影响将自我管理目标和健康评估与促进健康的互动活动联系起来 推广.使用实施科学框架并以中心干预为基础 有效性，这项研究将是第一个评估是否居中是可行的和可接受的， PrEP教育，导航和性工作者的依从性。初步定性研究39 芝加哥的性工作者强调，耻辱和医疗歧视阻止了性工作者 定期获得艾滋病毒预防信息、服务和治疗。与性工作者合作， 社区咨询委员会（CAB），我们在文化上调整了中心课程和主持人指南， 满足性工作者的需求。以探索、准备、实施和维持为导向 框架（EPIS），本研究的总体目标是扩大我的形成性研究，并评估这是否 文化适应的中心PrEP（C-PrEP+）模式是可行的，可接受的解决教育， 芝加哥HIV阴性性工作者的导航和PrEP依从性需求。本研究的具体目标是 到1.制定实施计划，将C-PrEP+整合到联邦合格医疗保健（CMEHC）中 系统2.开展C-PrEP+的可行性和可接受性试点试验。3.完成C-PrEP+的评估 记录实施障碍和促进因素。该研究计划将通过专家指导得到加强 并在伊利诺伊大学芝加哥和加州旧金山弗朗西斯科接受教学研究培训。这 提案，指导和课程将提供必要的职业发展：1。定量方法，2。 健康干预研究的设计、准备、实施和3.混合方法评价。这 基金会将独特地定位PI，以领导一项全面的多中心RCT，以确定C-PrEP+是否是一种 以有效和可持续模式解决性工作者中艾滋病毒预防问题。

Getting to Zero (GTZ) new HIV infections by 2030 is a public health priority. Increasing HIV prevention, self- management, and harm reduction among at-risk populations is critical. HIV prevalence in sex workers is 12 times greater than the general population, highlighting the need for targeted prevention efforts. Increasing optimal use of pre-exposure prophylaxis (PrEP) in this population will advance progress toward GTZ 2030. Community empowerment interventions reduce HIV risk among sex workers because interventions are collaboratively designed, implemented, and evaluated by the target population. A community-empowered PrEP navigation approach may be feasible and acceptable among sex workers. One such approach is a group healthcare model called Centering Healthcare (Centering), which originated as a group prenatal care model and has since been modified for various patient populations. Centering's three core components: healthcare, interactive learning, and community building, disrupt typical healthcare power hierarchies by creating a respectful and collaborative interactive learning environment that honors group needs. The model's positive impact links self-management goals and health assessment with interactive activities to foster health promotion. Using an implementation science framework and building on Centering intervention effectiveness, this study will be the first to evaluate whether Centering is feasible and acceptable for PrEP education, navigation, and adherence among sex workers. Preliminary qualitative research with 39 sex workers in Chicago highlighted that stigma and healthcare discrimination dissuaded sex workers from regularly accessing HIV prevention information, services, and treatment. In collaboration with sex workers and a Community Advisory Board (CAB), we culturally adapted the Centering curriculum and facilitator's guide to meet the stated needs of sex workers. Guided by an Exploration, Preparation, Implementation, Sustainment framework (EPIS), the overall goal of this study is to expand on my formative research and evaluate if this culturally adapted Centering PrEP (C-PrEP+) model is feasible and acceptable for addressing education, navigation and PrEP adherence needs of HIV negative sex workers in Chicago. Specific aims of this study are to 1. Produce an implementation plan for integrating C-PrEP+ into a Federally Qualified Health Care (FQHC) system. 2. Conduct a pilot feasibility and acceptability trial of C-PrEP+. 3. Complete an evaluation of C-PrEP+ to document implementation barriers and facilitators. The research plan will be augmented by expert mentoring and didactic research training at University of Illinois Chicago and University of California San Francisco. This proposal, mentoring, and coursework will provide essential career development in: 1. Quantitative methods, 2. Health intervention study design, preparation, implementation, and 3. Mixed-methodological evaluation. This foundation will uniquely position the PI to lead a fully powered multi-site RCT to determine if C-PrEP+ is an efficacious and sustainable model to address HIV prevention among sex workers.