Over thirty years into the United States epidemic, social disparities in HIV prevalence persist, with Black Americans, and Black men who have sex with men (MSM) in particular, disproportionately affected. Intensifying HIV prevention efforts in communities of high prevalence as well as maximizing the dissemination and impact of effective interventions are among the top national priorities for addressing HIV.1,2 The proposed training plan in this Mentored Research Scientist Development Award (K01) application will provide the essential knowledge and skills that the principal investigator, Sarah K. Calabrese, PhD, needs to launch a productive career in research targeting these public health imperatives. Further, the research conducted throughout the course of this award would contribute meaningfully to the successful delivery of pre-exposure prophylaxis (PrEP, i.e., oral antiretroviral medication for HIV prevention) in real-world clinical practice and could have far-reaching implications for equitable access across social lines. PrEP is a cutting-edge biomedical advancement that received United States Food and Drug Administration approval for prescription in July of 2012, sparking a push for its implementation in health care settings throughout the country. There has been mounting recognition of the need for provider training and education about PrEP3-7 and some discussion of cultural sensitivity being a component thereof,5 but minimal attention paid explicitly to the rik of disparate prescription practices. Documented discrimination in the prescription of antiretroviral medication for treatment purposes as well as preliminary evidence of biases in clinical judgment surrounding PrEP pose a call to action;the proposed research aims to address this call via the development and pilot testing of a single-session, group-based PrEP Awareness + Discrimination Prevention intervention for healthcare providers. The intervention will serve the dual purpose of increasing knowledge about PrEP among providers and averting discriminatory prescription practices using evidence-based strategies derived from social-cognitive psychology. The project will include a comprehensive needs assessment, including eight focus groups with potential PrEP providers from diverse clinical settings (n=48-64), six focus groups with Black MSM at risk for HIV acquisition (i.e., potential PrEP users;n=36-48), key informant interviews with healthcare providers who have experience prescribing PrEP (n=20), and a national quantitative survey of physicians (n=350). The intervention will be pilot tested in a two-armed randomized controlled trial with 80 healthcare providers seeking continuing medical education. The project will yield an intervention manual with detailed curriculum and supporting materials as well as preliminary indicators of intervention feasibility, acceptability, and effectiveness, setting the stage for future refinement and evaluation in the context of a larger-scale randomized controlled trial. The training acquired by Dr. Calabrese via this timely and innovative research project, in combination with formal coursework, focused workshops, academic conferences, manuscript preparation, grant-writing, one-on-one mentorship, and other research activities, will target the following three training objectives: (1)to gain mastery in the discipline of social-cognitive psychology on the topics of stereotyping, prejudice, and discrimination and to obtain training in measurement of implicit bias, (2) to gain expertise in intervention development, implementation, and evaluation, and (3) to enhance statistical analysis skills for application to planned research. Dr. Calabrese will be mentored primarily by John F. Dovidio, PhD, at Yale University, with additional mentoring from Nathan B. Hansen, PhD (Yale University), Kenneth H. Mayer, MD (Harvard Medical School/The Fenway Institute), Joseph R. Betancourt, MD, MPH (Harvard Medical School), and Manya Magnus, PhD, MPH (George Washington University). Dr. Calabrese's training through the proposed K01 award will round out her expertise and fully prepare her for a career as an independent research scientist in the field of HIV prevention.

Public Health Relevance

Pre-Exposure Prophylaxis (PrEP), a prescription-based daily oral medication for primary prevention of HIV, adds an exciting new option to the growing arsenal of prevention strategies available to individuals at risk for HIV acquisition. As PrEP is introduced into real-world clinical settings, educating potential prescribers about PrEP and ensuring equitable prescription practices are essential given preliminary indicators of racial bias in PrEP-related clinical decision-making. The proposed research aims to develop and pilot test a single-session, group-based intervention for providers to increase their awareness about PrEP and promote equitable prescription practices, ultimately increasing access to PrEP and combating the spread of HIV.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Scientist Development Award - Research & Training (K01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Gordon, Christopher M
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Yale University
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New Haven
United States
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Calabrese, Sarah K (2018) Interpreting Gaps Along the Preexposure Prophylaxis Cascade and Addressing Vulnerabilities to Stigma. Am J Public Health 108:1284-1286
Calabrese, Sarah K; Earnshaw, Valerie A; Krakower, Douglas S et al. (2018) A Closer Look at Racism and Heterosexism in Medical Students' Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education. AIDS Behav 22:1122-1138
Tekeste, Mehrit; Hull, Shawnika; Dovidio, John F et al. (2018) Differences in Medical Mistrust Between Black and White Women: Implications for Patient-Provider Communication About PrEP. AIDS Behav :
Calabrese, Sarah K; Earnshaw, Valerie A; Magnus, Manya et al. (2018) Sexual Stereotypes Ascribed to Black Men Who Have Sex with Men: An Intersectional Analysis. Arch Sex Behav 47:143-156
Underhill, Kristen; Guthrie, Kate M; Colleran, Christopher et al. (2018) Temporal Fluctuations in Behavior, Perceived HIV Risk, and Willingness to Use Pre-Exposure Prophylaxis (PrEP). Arch Sex Behav 47:2109-2121
Calabrese, Sarah K; Dovidio, John F; Tekeste, Mehrit et al. (2018) HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood. J Acquir Immune Defic Syndr 79:46-53
Calabrese, Sarah K; Underhill, Kristen; Mayer, Kenneth H (2018) Calabrese et al. Respond. Am J Public Health 108:e1-e2
Calabrese, Sarah K; Underhill, Kristen; Mayer, Kenneth H (2017) HIV Preexposure Prophylaxis and Condomless Sex: Disentangling Personal Values From Public Health Priorities. Am J Public Health 107:1572-1576
Calabrese, Sarah K; Magnus, Manya; Mayer, Kenneth H et al. (2017) ""Support Your Client at the Space That They're in"": HIV Pre-Exposure Prophylaxis (PrEP) Prescribers' Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS 31:196-204
Calabrese, Sarah K; Krakower, Douglas S; Mayer, Kenneth H (2017) Integrating HIV Preexposure Prophylaxis (PrEP) Into Routine Preventive Health Care to Avoid Exacerbating Disparities. Am J Public Health 107:1883-1889

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