Improving the HIV PrEP Cascade using an Intervention for Healthcare Providers

使用医疗保健提供者干预措施改善 HIV PrEP 级联

• 批准号: 10176701
• 负责人: Parya Saberi
• 金额: $ 16.15万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176701
• 关键词: AIDS prevention; Address; Adherence; Adult; Appointment; Award; Awareness; Behavioral; Benefits and Risks; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinic; Clinical; Continuity of Patient Care; Data; Education; Ensure; Ethnic Origin; Formulation; Gender; Goals; HIV; HIV risk; Health Personnel; Individual; Intervention; Interview; Knowledge; Laboratories; Monitor; Online Systems; Outcome; Parents; Patient risk; Patients; Phase; Population; Prevention strategy; Primary Health Care; Privatization; Provider; Public Health; Race; Randomized Clinical Trials; Recommendation; Recording of previous events; Registries; Reporting; Research; Resources; Risk; Risk Assessment; Role; San Francisco; Schedule; Sexually Transmitted Diseases; Speed; Standardization; Structure; Surveys; System; Test Result; Testing; Time; Training; Visit; base; dashboard; design; early experience; experience; follow-up; high risk; improved; innovation; interest; knowledge base; novel; pre-exposure prophylaxis; response; sex; support tools; tool; uptake; willingness

Parent Award Project Summary/Abstract HIV pre-exposure prophylaxis (PrEP) has been shown to be highly effective for HIV prevention in randomized clinical trials but uptake of PrEP in the U.S. has been limited. One of the barriers to PrEP implementation is lack of healthcare provider (HCP) knowledge and willingness to prescribe it. As outcomes of current PrEP formulations in real-world settings and different populations are reported and novel PrEP formulations are introduced, HCPs will continue to require support and guidance to optimize the clinical and public health impact of this valuable HIV prevention strategy. We propose a PrEP optimization intervention targeted at HCPs to increase PrEP uptake and persistence among those at risk for HIV acquisition. This intervention includes: (1) an integrated web-based panel management tool called PrEP-Rx, which provides structured HIV risk assessment, automates reminders for laboratory testing and appointments, and reports patients' history of PrEP use; and (2) a centralized PrEP coordination overseen by a clinical support staff (referred to as the PrEP coordinator) who can identify individuals at high risk for HIV through direct patient contact or by reviewing registries for sexually transmitted infections (STIs) and who can support multiple HCPs. We propose the following aims: Primary Aim: Evaluate the efficacy of the PrEP optimization intervention (PrEP Coordinator + PrEP-Rx) to increase PrEP prescriptions through a stepped-wedge design among 10 primary care clinics. We hypothesize that the mean number of prescriptions issued will be significantly higher when the clinics use the PrEP intervention versus when they do not. Secondary Aims: (1) Explore differences in PrEP initiation, duration of use, and reasons for discontinuation based on patient's age, race/ethnicity, and sex/gender, and by clinic and HCP characteristics among study clinics; (2) Explore sustainability of the intervention during an eight-month follow-up after the stepped-wedge Phase; (3) Investigate facilitators and barriers of PrEP delivery and experiences with the proposed PrEP intervention through qualitative interviews with HCPs, PrEP Coordinators, and clinic directors of study clinics. The combination of the PrEP Coordinator plus PrEP-Rx has the potential to improve all steps of the PrEP continuum and enhance overall care by identifying individuals at high risk of HIV acquisition, standardizing HIV risk assessment, helping in PrEP initiation, systematizing follow- up visits or laboratory assessments, and educating HCPs about emerging PrEP data. These goals can have a significant public health impact and be attained with minimal burden on existing clinic resources. We are using innovative approaches for PrEP delivery which will result in training of HCPs to increase the number of HCPs capable of offering PrEP. Ultimately, the proposed research has the potential to reduce gaps in the PrEP cascade.

家长奖项目摘要/摘要 HIV暴露前预防（PREP）已被证明对预防HIV非常有效 临床试验，但在美国的PREP吸收受到限制。准备实施的障碍之一是 缺乏医疗保健提供者（HCP）知识和开处方的意愿。作为当前准备的结果 现实环境中的配方报告和不同的种群，新颖的准备配方是 引入的，HCP将继续需要支持和指导以优化临床和公共卫生影响 这项有价值的艾滋病毒预防策略。我们提出针对HCP的PREP优化干预措施 增加有艾滋病毒感染风险的人的预备摄取和持久性。此干预措施包括：（1） 一种基于Web的集成面板管理工具，称为PreP-RX，该工具提供结构化的HIV风险 评估，自动提醒实验室测试和任命，并报告患者的病史 准备使用； （2）由临床支持人员监督的集中准备协调（称为PREP 协调员）可以通过直接患者联系或通过审查来识别艾滋病毒高风险的人 性传播感染（STI）的注册机构，谁可以支持多个HCP。我们建议 以下目的：主要目的：评估准备优化干预的疗效（PrepSodinator + PREP-RX）通过10个初级保健诊所中的跨斜向设计来增加准备处方。我们 假设诊所使用时，发出的处方的平均数量将显着更高 预备干预与不进行时。次要目的：（1）探索准备启动的差异， 使用持续时间以及基于患者的年龄，种族/种族和性别/性别的停用原因 研究诊所之间的诊所和HCP特征； （2）探索干预措施的可持续性 阶梯末期后八个月的随访； （3）调查促进者和准备交付的障碍 以及通过与HCP的定性访谈，准备的拟议准备干预的经验 研究诊所的协调员和诊所主管。准备协调器加Prep-Rx的组合具有 通过识别个人来改善预备连续体的所有步骤并增强整体护理的潜力 艾滋病毒获取的高风险，标准化艾滋病毒风险评估，有助于准备启动，系统化后续 - 提高访问或实验室评估，并教育HCP有关新兴准备数据的教育。这些目标可以有一个 公共卫生的重大影响，并承担现有诊所资源的最小负担。我们正在使用 准备交付的创新方法将导致培训HCP以增加HCP的数量 能够提供准备。最终，拟议的研究有可能减少准备的差距 级联。