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 risk 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.
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.
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