Identifying Community-Informed DoxyPEP Implementation Strategies to Guide Equitable Delivery of Syphilis Prevention

项目摘要/摘要 在R21提案中，我们将使用实施科学方法来研究公平梅毒的交付 以临床为基础的预防，多西环素暴露后预防(DoxyPEP)。创新战略， 需要预防梅毒，以应对日益增长的全国性流行病，并带来不成比例的疾病负担 在与男性发生性行为的黑人和西班牙裔/拉丁裔性少数群体和性别少数群体中。在……里面 特别是芝加哥，梅毒发病率一直在稳步上升，与艾滋病毒传播同步。现有公众 卫生应对措施--接触者追踪、检测和治疗--并未阻止这些上升的比率。最新数据 显示在性行为后服用的多西环素在预防梅毒方面非常有效 暴露了。作为一种新兴的循证干预措施，需要关键的实施信息来确保 公平地提供doxyPEP以最大限度地发挥对梅毒流行的影响。正如其他人所认识到的 生物医学预防工具，如艾滋病毒暴露前预防，及早确定分娩障碍是 势在必行。拟议的研究将使用以下实施框架解决doxyPEP交付方面的差距 与伊利诺伊州芝加哥以SGM为重点的卫生系统建立伙伴关系，以实现以下目标：1)评估 在患者、提供者和卫生系统层面上使用doxyPEP的决定因素；2)确定和选择社区- 知情的实施战略，支持在受梅毒影响最严重的人群中使用doxyPEP 流行病；以及3)开发和评估doxyPEP的可接受性、可行性和适当性 患者、提供者和卫生系统利益相关者之间的实施战略包。我们的混合体 方法办法将植根于实施研究综合框架(CFIR)和 能力、机会和动机行为模型(COM-B)，结合定性方法和 联合分析方法，以确定doxyPEP服务交付的重要决定因素。建议数 研究将产生实施战略，以指导公平使用多西环素暴露后预防 在受梅毒影响最大的人群中。

Project Summary/Abstract In this R21 proposal, we will use implementation science approaches to study delivery of equitable syphilis prevention, doxycycline post-exposure prophylaxis (doxyPEP), in a clinic-based setting. Innovative strategies for syphilis prevention are needed to address the growing national epidemic, with disproportionate burden of disease among Black and Hispanic/Latinx sexual and gender minority persons (SGM) who have sex with men. In Chicago specifically, syphilis rates have been rising steadily, syndemic with HIV transmission. Existing public health responses – contact tracing, testing, and treatment – have not stemmed these rising rates. Recent data show that doxycycline, taken after sexual activity, is very effective at prevention of syphilis for those who may be exposed. As an emerging evidence-based intervention, key implementation information is needed to ensure equitable delivery of doxyPEP to maximize impact on the syphilis epidemic. As has been recognized with other biomedical prevention tools such as HIV pre-exposure prophylaxis, early identification of barriers to delivery is imperative. The proposed study will address gaps in doxyPEP delivery using implementation frameworks in partnership with an SGM-focused health system in Chicago, Illinois, to meet the following aims: 1) Assess determinants of doxyPEP use at the patient, provider and health system levels; 2) Identify and select community- informed implementation strategies to support doxyPEP use among populations most affected by the syphilis epidemic; and 3) Develop and evaluate acceptability, feasibility, and appropriateness of a doxyPEP implementation strategy package among patients, providers, and health systems stakeholders. Our mixed methods approach will be rooted in the Consolidated Framework for Implementation Research (CFIR) and the Capability, Opportunity, and Motivation Model of Behavior (COM-B), incorporating qualitative methods and conjoint analysis approaches, to identify important determinants of doxyPEP service delivery. The proposed research will result in implementation strategies to guide equitable use of doxycycline post-exposure prophylaxis among populations most impacted by syphilis.