Using Implementation Science to Enhance HIV Prevention for Young Men - PROJECT SUMMARY/ABSTRACT Background: Young men bear a disproportionate burden of HIV incidence in the U.S. Though pre-exposure prophylaxis (PrEP) use is increasing among young men at risk for HIV (YMRH), dropout from care is high, and YMRH are more likely than older men to contract HIV after discontinuing PrEP. Existing CDC-recommended evidence-based practices (e.g., motivational interviewing, personalized health education, linkage to couples HIV testing) can increase retention in care and use of PrEP and other effective HIV prevention methods among YMRH. Research is needed to facilitate their delivery in diverse clinic settings. Present Study: The proposed mentored patient-oriented career development award (K23) project will use implementation science methods to identify and evaluate strategies to implement these evidence-based practices (hereafter, “HIV Prevention Plus Care” or “HP+ Care”) with YMRH starting PrEP in two clinic settings. HP+ Care will include MI and personalized health education to promote retention in care and use of PrEP and other prevention methods. Specific aims are: (1) using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, investigate factors influencing implementation of HP+ care for YMRH in the constructs of recipients (staff), context (clinics), and innovation (CDC-recommended evidence-based practices); (2) using Aim 1 data, identify appropriate Expert Recommendations in Implementing Change (ERIC) implementation strategies to deliver HP+ Care in two clinics; and (3) pilot the implementation strategies in two clinics to assess feasibility, acceptability, and appropriateness. Candidate: Andrew Barnett, Ph.D., is a faculty psychologist in the HIV program at Children’s National Hospital whose research focuses on promoting health, including HIV prevention, among adolescents and young adults. Mentoring: The primary mentor, Dr. David Huebner, is an expert in HIV preventive interventions for YMRH, and four co-mentors have complementary expertise in rigorous quantitative analysis methods (Dr. Barker); HIV prevention and PrEP engagement in clinic settings (Dr. Chan); leading multisite research investigations to enhance HIV care or prevent HIV (Dr. Brown); and applying implementation science methods to improve delivery of evidence-based practices in healthcare (Dr. Elwy). Training: Training activities will advance the following goals: (1) gain experience in conducting implementation science investigations to prevent HIV in healthcare settings; (2) expand knowledge of novel biomedical HIV prevention approaches, including PrEP on-demand, long-acting injectable PrEP, and other modalities currently under development; (3) gain expertise in methods for quantitative analysis of clustered data, including hierarchical linear modeling; and (4) advance professional development, research ethics, and grants management skills. Training will prepare the candidate to conduct NIH-funded independent investigations.
