PrEP Connect: Bridging HIV Testing to PrEP Screening and Uptake

项目总结 该提案回应了PA-19-050《让男性参与艾滋病毒检测、预防和护理》和NOT-MD-19- 001性少数群体和性别少数群体健康研究特别关注通知。 艾滋病毒检测是降低艾滋病毒传播率的重要第一步，但预防咨询 组件近年来已大幅减少，并且未纳入经过验证的PrEP推荐 过程作为护理的标准。对于那些最需要预防服务的人，额外的障碍包括 种族歧视和社会耻辱对小岛屿发展中国家的累积影响 持久的艾滋病毒污名。这些力量对艾滋病毒检测和预防的影响得到了广泛承认，但 仍然是极难干预的。这项探索性研究结合了一种创新的参与式 方法和交叉污名框架，以了解黑人SGM在南方城市的经历 艾滋病毒/性传播感染检测和PrEP转诊。我们建立在现有的模拟客户/患者方法的基础上， 并解释健康环境中的互动行为，以接近实时的方式捕捉黑色SGM体验 以及靠近他们接受测试和PrEP服务的环境。我们的目标是了解 对模拟客户/患者的主观体验，不对提供者进行客观评价。在AIM 1我们将(A)招聘和培训8名黑人SGM，以扮演模拟客户/患者访问的角色 艾滋病毒/性传播感染检测和预防接种计划服务；(B)与提供者进行模拟演练，以 记录并描述他们提供服务的标准模式，并协商如何模拟的协议 客户/患者将获得他们的服务。在AIM中，2个模拟客户/患者将完成结构化调查 紧接在与提供商的每次接洽之前和之后(n=32次活动)，然后进行定性汇报 面试。然后，我们将与供应商进行深入访谈，了解他们对这些类型的看法 报告的经验。定性编码和结构化调查数据将使用基于矩阵的 应用主题分析方法，包括使用频率表和可视化技术进行比较 并对比黑人SGM在污名、歧视、赋权和确认方面的交叉经历。 AIM 3的中心是与包括黑人SGM和供应商在内的利益攸关方共同绘制参与式干预地图 审查预防经验的范围，并协作确定改善(A)转诊/吸纳的方法 经验，(B)提供者确定可能受益于PrEP的客户的能力，以及(C)与 风险最高的客户采用PrEP。研究结果将对以下方面的本地质量改进具有直接价值 服务，告知在北卡罗来纳州更广泛地扩大艾滋病毒预防服务，并告知 开发以公平为基础的提供者培训干预措施，以减少交叉污名的经历 针对黑人SGM获得艾滋病毒预防服务。

PROJECT SUMMARY This proposal responds to PA-19-050 Engaging Men in HIV Testing, Prevention, and Care and to NOT-MD-19- 001 Notice of Special Interest in Research on the Health of Sexual and Gender Minority (SGM) Populations. HIV testing is an essential first step in reducing HIV transmission rates, but the prevention counseling component has been significantly reduced in recent years and has not incorporated validated PrEP referral processes as standard of care. For those most in need of prevention services additional barriers include the cumulative impact of experiences of racial discrimination and social stigma against SGMs compounded with persistent HIV stigma. The impact of these forces on HIV testing and prevention are widely acknowledged but remain extremely difficult to intervene upon. This exploratory study combines an innovative participatory approach and intersectional stigma framework to understand how black SGM in a Southern city experience HIV/STI testing and PrEP referral. We build on existing simulated client/patient approaches to elicit, observe, and interpret interactional behaviors in health settings to capture black SGM experiences in close to real time and proximity to the environments where they receive testing and PrEP services. The goal is to understand the subjective experience of the simulated client/patient, not conduct an objective evaluation of the provider. In Aim 1 we will (a) recruit and train eight black SGM to perform in the role of a simulated client/patient accessing HIV/STI testing and PrEP services and (b) conduct simulated walk-through exercises with providers to document and describe their standard mode of service delivery and negotiate agreements for how simulated clients/patients will access their services. In Aim 2 simulated clients/patients will complete structured surveys immediately before and after each engagement with a provider (n=32 events) followed by a qualitative de-brief interview. We will then conduct in-depth interviews with providers to understand their perspectives on the types of experiences reported. Qualitative coding and structured survey data will be combined using a matrix-based applied thematic analysis approach, including use of frequency tables and visualization techniques to compare and contrast black SGM intersectional experiences of stigma, discrimination, empowerment, and confirmation. Aim 3 centers on participatory intervention mapping with stakeholders including black SGM and providers to review the range of prevention experiences and collaboratively identify ways to improve (a) the referral/intake experience, (b) the capacity of providers to identify clients likely to benefit from PrEP, and (c) linkage to and uptake of PrEP by clients at highest risk. Findings will be of immediate value for local quality improvement in services, inform the expansion of HIV prevention services more broadly in North Carolina, and inform development of an equity-based provider training intervention to reduce experiences of intersectional stigma for black SGM accessing HIV prevention services.