Adaptation of a PrEP Shared-Decision Making Tool for Family Planning Clinics

项目总结/摘要 在美国，顺性别女性占新感染艾滋病毒人数的20%左右，并且系统性地获得不足 预防艾滋病。患者方面障碍的交叉点（缺乏患者知识，感知风险， 医疗上的不信任），以及提供者方面的障碍（缺乏知识，对预防咨询感到不适， 偏见）影响了新的艾滋病毒预防方法的采用，例如现有的和即将到来的预防方法， 预防艾滋病毒（口服、注射等）的药物预防（PrEP）。为了克服这些障碍，受训者（安德森女士） 将调整计划生育（FP）共同决策（SDM）工具，用于艾滋病毒预防咨询。 SDM包括引入选择，描述选项，并探索患者的偏好，以帮助医疗保健 决定，同时赋予妇女权力，减少提供者偏见，提高对护理的满意度，并增加 坚持护理方案。调整后的工具将与供应商一起测试可接受性/可行性， 标题X联邦资助的FP诊所的客户，这是一个高接触环境，为异性恋者带来艾滋病毒风险的妇女 contact.在ADAPT-ITT适应框架的指导下，具体目标是：（1）评估 通过（a）具有标题的重点小组， 亚特兰大地铁的X供应商（K=4，N=32）和（B）剧院测试与种族/民族多样化的顺- 性别成人Title X客户（N=40）;（2）采用基于证据的世界卫生组织（WHO）决定- 为计划生育客户和提供者制作艾滋病毒预防工具;以及（3）进行混合方法可接受性/fea- 使用Title X提供者（N=40）和客户端（N=40）对适配的SDM工具进行可行性测试。这项研究将导致 一个可接受的和可行的艾滋病毒预防SDM工具，用于在计划生育诊所就诊的顺性别妇女， 进一步测试和传播，以促进妇女预防艾滋病毒，推动消除艾滋病毒的努力， 疫情此外，这项工作将支持安德森女士的培训，她致力于成为一名 高素质，NIH资助的研究人员在艾滋病毒预防和治疗，并改善护理的相互作用。 女士安德森的3年培训计划包括：（1）正式发展实施中的方法技能 科学和以人为本的设计，（2）提高对临床艾滋病毒预防背景的理解， 包括生物医学预防和临床互动，以及（3）发展测量领域的技能 以及干预措施和干预途径的评价。导师团队，销售博士（主要赞助商）， Sort）、Sheth（共同赞助商）和Kottke（专家顾问）将为Ms. 安德森在她的培训过程中，在主题领域的实施科学，艾滋病毒预防，临床， cal相互作用和干预评估。安德森女士将利用埃默里大学的资源，包括- 评价和实施科学网络、评价和实施网络 科学，妇女和儿童中心，和预防研究中心。候选人，导师 团队和环境都非常适合实现拟议的研究和培训目标。

PROJECT SUMMARY/ABSTRACT Cisgender women account for ~20% of new HIV infections in the US, and are systematically under-accessed for HIV prevention. The intersection of patient-side barriers (lack of patient knowledge, perceived risk, and medical mistrust), and provider-side barriers (lack of knowledge, discomfort with prevention counseling, and bias) impacts uptake of novel HIV prevention methods, such as available and forthcoming methods of pre-ex- posure prophylaxis (PrEP) for HIV (oral, injectable, etc.). To address these barriers, the trainee (Ms. Anderson) will adapt a family planning (FP) shared decision-making (SDM) tool for use in HIV prevention counseling. SDM involves introducing choice, describing options, and exploring patient preferences to aid in health care decisions, while empowering women, decreasing provider bias, increasing satisfaction with care, and increas- ing adherence to care regimens. The adapted tool will be tested for acceptability/feasibility with providers and clients at Title X federally-funded FP clinics, a high-reach setting for women at risk for HIV from heterosexual contact. Guided by the ADAPT-ITT framework for adaptation, the specific aims are to (1) assess the utility of SDM practices for HIV prevention and barriers/facilitators to implementation, through (a) focus groups with Title X providers in Metro Atlanta (K=4, N=32) and (b) theater testing interviews with racially/ethnically diverse cis- gender adult Title X clients (N=40); (2) adapt the evidence-based World Health Organization (WHO) Decision- Making Tool for FP Clients and Providers for HIV prevention; and, (3) conduct mixed-method acceptability/fea- sibility testing of the adapted SDM tool with Title X providers (N=40) and clients (N=40). This study will result in an acceptable and feasible HIV prevention SDM tool for use with cisgender women attending FP clinics, to be further tested and disseminated to promote HIV prevention among women, advancing efforts to end the HIV epidemic. Additionally, this work will support the training of Ms. Anderson, who is committed to becoming a high caliber, NIH-funded researcher in HIV prevention and treatment, and improvement of care interactions. Ms. Anderson’s 3-year training plan includes: (1) formally developing methodological skills in implementation science and human-centered design, (2) advancing understanding of the context of clinical HIV prevention, including biomedical prevention and clinical interactions, and (3) developing skills in the areas of measurement and evaluation of interventions and interventional pathways. The team of mentors, Drs. Sales (Primary Spon- sor), Sheth (Co-Sponsor), and Kottke (Expert Advisor), will provide oversight, guidance, and mentorship to Ms. Anderson during the course of her training, in the topic areas of implementation science, HIV prevention, clini- cal interactions, and intervention evaluation. Ms. Anderson will leverage resources at Emory University, includ- ing the Network for Evaluation and Implementation Sciences, the Network for Evaluation and Implementation Science, the Women and Children’s Center, and the Prevention Research Center. The candidate, mentorship team, and the environment are extremely well situated to achieve the proposed research and training aims.