The purpose of this Mentored Research Scientist Career Development Award (K01) application is to develop Dr. Sarah Beckham?s career as an independent investigator in implementation science to optimize evidence- based HIV interventions in low-income countries, particularly among high-risk women. This K01 will provide the necessary support to achieve the following goals: 1) to become an expert in implementation science theories and methods in public health; 2) to gain training in the theory and application of stated-preferences methods, particularly discrete-choice experiments (DCE); 3) to conduct preference heterogeneity analyses of stated- preference data using latent class finite-mixtures models; 4) to become an expert in pre-exposure prophylaxis (PrEP) implementation research, particularly in low-income countries. To support these goals, Dr. Beckham has a mentoring team of her primary mentor, Dr. Deanna Kerrigan, a specialist in implementation of community-based HIV interventions for high-risk women; three co-mentors, Dr. John FP Bridges, an expert in stated-preferences methods; Dr. Chris Beyrer, a leading HIV researcher with expertise in PrEP implementation for high-risk populations; and Dr. Noya Galai, a biostatistician who applies her skills to the development and application of methods to public health; and a collaborator, Dr. Jessie Mbwambo, a leading researcher in sub- Saharan Africa (SSA), specializing in implementing HIV interventions for high-risk populations. Given the high burden of HIV among female sex workers (FSW), integrating PrEP into HIV services is an urgent priority and requires implementation science research to identify optimal patient-focused strategies and drug formulations (e.g. tablet, injectable, cervical ring) that are acceptable to the intended populations and reaffirm their dignity, rights, and choice. The goal of this study is to measure high-risk women?s preferences for PrEP and explore healthcare provider-level challenges, to inform future optimal implementation of PrEP into community-based interventions. To achieve these goals, this study has the following research aims: 1) Quantify high-risk women?s stated preferences for PrEP through a discrete choice experiment (DCE) comparing key attributes of PrEP (e.g. formulation, side effects, stigma, access).
This aim will embed and analyze a DCE in the parent project survey. 2) Identify preference heterogeneity across the different attributes of PrEP using a latent class finite-mixture model to account for differences between groups of respondents (?latent classes?). 3) Identify barriers and facilitators to healthcare providers? willingness to prescribe PrEP to high-risk women and develop a provider readiness tool, using key informant and semi-structured interviews of healthcare providers and health sector officials and the adaptable Tailored Implementation for Chronic Diseases checklist to guide the development of the tool. This training and research plan will produce preliminary data to inform an R01 application to conduct implementation research on integrating preferred formulations of PrEP into combination prevention interventions for high-risk women in Tanzania or a similar setting.

Public Health Relevance

Pre-exposure prophylaxis (PrEP) medications for HIV prevention hold significant promise as part of a comprehensive package of combination HIV services in Sub-Saharan Africa and globally. However, understanding the challenges of on-the-ground implementation is critical to ensure its acceptability, and thus its use. Measuring the preferences of women at heightened risk and exploring the challenges to health care providers? willingness and ability to prescribe PrEP can optimize integration of this life saving treatment into routine practice to ensure it reaches the populations most in need.

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)
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Senn, Theresa Elaine
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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