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.

家长奖项目总结/摘要 HIV 暴露前预防 (PrEP) 已被证明对 HIV 预防非常有效。 临床试验，但 PrEP 在美国的应用有限。 PrEP 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 PrEP 的结果 报告了现实世界环境和不同人群中的制剂，并提出了新颖的 PrEP 制剂 据介绍，HCP 将继续需要支持和指导，以优化临床和公共卫生影响 这一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 提高 HIV 感染风险人群的 PrEP 接受率和持久性。这种干预包括：(1) 名为 PrEP-Rx 的基于网络的综合面板管理工具，可提供结构化的 HIV 风险 评估，自动提醒实验室检测和预约，并报告患者的病史 PrEP 的使用； (2) 由临床支持人员监督的集中 PrEP 协调（称为 PrEP） 协调员）可以通过直接接触患者或通过审查来识别艾滋病毒高危人群 性传播感染 (STI) 登记处以及可以支持多名 HCP 的人员。我们建议 以下目标： 主要目标：评估 PrEP 优化干预的效果（PrEP 协调员 + PrEP-Rx）通过 10 个初级保健诊所的阶梯式楔形设计来增加 PrEP 处方。我们 假设当诊所使用 PrEP 干预与不干预时的比较。次要目标：(1) 探索 PrEP 启动的差异， 根据患者的年龄、种族/民族和性别，以及 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 阶梯楔形阶段后八个月的随访； (3) 调查 PrEP 实施的促进因素和障碍 以及通过与 HCP、PrEP 进行定性访谈而提出的 PrEP 干预的经验 研究诊所的协调员和诊所主任。 PrEP 协调器与 PrEP-Rx 的组合具有 通过识别个人，有可能改进 PrEP 连续体的所有步骤并加强整体护理 HIV 感染的高风险、标准化 HIV 风险评估、帮助启动 PrEP、系统化后续行动 进行访视或实验室评估，并对 HCP 进行有关新出现的 PrEP 数据的教育。这些目标可以有 显着的公共卫生影响，并且可以在对现有诊所资源造成最小负担的情况下实现。我们正在使用 PrEP 交付的创新方法将导致对 HCP 进行培训，以增加 HCP 的数量 能够提供 PrEP。最终，拟议的研究有可能缩小 PrEP 方面的差距 级联。