Developing an Implementation Program to Optimize Uptake of HIV Pre-Exposure Prophylaxis among Black Women in Primary Care Settings

Baylor College Of Medicine, Houston TX

Investigators

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Abstract

? DESCRIPTION (provided by applicant): Dr. Charlene Flash is an Assistant Professor of Medicine at Baylor College of Medicine. Her long-term career goal is to become an independent investigator and national leader in eliminating health care disparities in HIV. She strives to master the development and evaluation of theory-driven approaches to bio-behavioral HIV prevention, including pre-exposure prophylaxis (PrEP), among at-risk Black women. Dr. Flash will accomplish this goal through patient-oriented research, formal mentoring by recognized experts (Drs. Thomas Giordano, Kenneth Mayer, Rivet Amico, Jeffrey Cully and Adaora Adimora) and advanced training in behavioral science, mixed-methodology, and implementation science. The applicant's K23 research goal is to develop an HIV prevention program for Black women in primary care settings that facilitates access to PrEP. The overall hypothesis is that modifiable patient and provider features influence uptake of biobehavioral prevention. Understanding the influence of these features on CDC HIV PrEP guideline uptake can guide design of an innovative, culturally relevant HIV prevention program. The Program's objective is for Black women engaged in primary care settings to be screened for risk, made aware of PrEP and be able to access PrEP via an informed and equipped provider if the patient is both high risk and interested. Addressing four NIMH high priority areas, this research integrates behavioral and biomedical approaches, incorporates context, and uses implementation science in vulnerable populations. The first specific aim is to use patient and provider surveys and interviews, grounded in the PARiHS implementation framework, to assess how Black women and their providers approach sexual health, assess HIV risk, and perceive PrEP. The second aim is to develop a PrEP Implementation Program to increase HIV risk assessments among Black women and appropriate PrEP uptake among those at-risk. We will develop and iteratively revise a clinical algorithm to increase HIV risk assessments, PrEP discourse, and PrEP prescribing when appropriate. The algorithm will be informed by data from AIM 1, existing literature, and input from a Multidisciplinary Advisory Board that includes experts in PrEP and implementation science, clinical providers, and at risk Black women patients. The third specific aim is to use a type 3 effectiveness-implementation hybrid design with pre-post evaluation to pilot and evaluate the PrEP Implementation Program in a primary care clinic that serves Black women of low socioeconomic status living in a high HIV incidence zip code. As additional oral, topical and injectable chemoprophylaxis agents emerge, this work will facilitate their integration into existing health care structures. This research will expand upon the principal investigator's current skills and past work, take advantage of an outstanding research and mentoring environment, and develop an independent researcher whose work decreases HIV incidence among Black women.