PrEP Connect: Bridging HIV Testing to PrEP Screening and Uptake

项目摘要 本提案是对PA-19-050《让男性参与艾滋病毒检测、预防和护理》和NOT-MD-19- 001关于性和性别少数群体（SGM）健康研究的特别兴趣通知。 艾滋病毒检测是降低艾滋病毒传播率必不可少的第一步， 近年来，这一组成部分已显着减少，并没有纳入经验证的PrEP转介 作为护理标准。对于那些最需要预防服务的人来说，其他障碍包括： 种族歧视和社会污名对特别委员会的累积影响， 艾滋病的持续耻辱。这些力量对艾滋病毒检测和预防的影响得到广泛承认， 仍然很难干预。这项探索性研究结合了创新的参与性 方法和交叉污名框架，以了解南方城市的黑人SGM如何经历 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/病人的方法，以引起，观察， 并解释健康环境中的干扰行为，以接近真实的时间捕捉黑人SGM体验 以及接近他们接受测试和PrEP服务的环境。目标是了解 模拟客户/患者的主观体验，而不是对提供者进行客观评价。在Aim中 1.我们将（a）招募和培训8名黑人SGM，以模拟客户/患者访问 艾滋病毒/性传播感染检测和PrEP服务，以及（B）与提供者进行模拟演练， 记录并描述他们的标准服务交付模式，并就如何模拟 客户/患者将获得他们的服务。在目标2中，模拟客户/患者将完成结构化调查 在每次与提供者接触（n=32起事件）之前和之后立即进行，随后进行定性汇报 采访然后，我们将与供应商进行深入访谈，以了解他们对类型的看法 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 应用专题分析方法，包括使用频率表和可视化技术进行比较 并对比黑人SGM的耻辱，歧视，授权和确认的交叉经验。 目标3的核心是与利益相关者（包括黑人SGM和供应商）一起参与干预绘图， 审查预防经验的范围，并合作确定如何改进（a）转诊/接收 经验，（B）提供者识别可能从PrEP中受益的客户的能力，以及（c）与 风险最高的客户使用PrEP。调查结果将对当地质量的改善具有直接价值， 服务，为北卡罗来纳州更广泛地扩大艾滋病毒预防服务提供信息，并为 制定基于公平的供应商培训干预措施，以减少交叉羞辱的经历 获得艾滋病预防服务的机会。

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.