Meet me where I am: A multilevel strategy to increase PrEP uptake and persistence among young sexual and gender minority men in rural NC

在我所在的地方见我：提高北卡罗来纳州农村年轻性少数男性和性别少数男性的 PrEP 接受率和持久性的多层次战略

• 批准号: 10508184
• 负责人: Kathryn E Muessig
• 金额: $ 61.8万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-13 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10508184
• 关键词: AIDS prevention; Accounting; Address; Area; Behavioral; Caring; Client; Clinic; Clinic Visits; Collaborations; Complement; Consensus; Cost Effectiveness Analysis; County; Development; Drug usage; Effectiveness; Enrollment; Epidemic; Financial Support; Future; Geography; Goals; HIV; HIV Infections; HIV diagnosis; HIV-1; Health; Healthcare; Heterogeneity; Human Resources; Individual; Infection; Infrastructure; Insurance; Interruption; Intervention; Interview; Knowledge; Link; Modeling; North Carolina; Outcome; Pathway interactions; Patients; Persons; Phase; Policies; Population; Poverty; Prevention strategy; Process; Provider; Ramp; Randomized; Research Personnel; Resources; Risk; Rural; Rural Health; STI prevention; Services; Sexual and Gender Minorities; Sexually Transmitted Diseases; Structure; Surveys; Training; United States; Update; Urban Health; Visit; Work; antiretroviral therapy; base; budget impact; cost; cost effective; cost effectiveness; cost estimate; demographics; design; digital health; effectiveness evaluation; effectiveness outcome; evidence base; flexibility; gender minority group; gender minority men; implementation evaluation; implementation fidelity; implementation outcomes; implementation science; implementation strategy; improved; intervention cost; intervention mapping; meetings; metropolitan; peer; people of color; peri-urban; pre-exposure prophylaxis; primary outcome; prospective; racial disparity; randomized trial; rural area; rural counties; scale up; social stigma; success; support tools; syndemic; telehealth; tool; transmission process; uptake; urban area

PROJECT SUMMARY Improved linkage to and uptake of pre-exposure prophylaxis (PrEP) is critical to end the HIV epidemic in the United States (US). Despite PrEP’s high efficacy, less than 20% of PrEP-eligible people have received a prescription and gaps in uptake expose regional and racial disparities. In 2018, the US South accounted for more than half of all new HIV diagnoses but only one-third of PrEP users. PrEP use in North Carolina (NC) similarly lags, with uptake lowest among young sexual and gender minority populations (YSGM) who account for nearly two-thirds of the state’s incident infections. Among NC counties with the highest rate of HIV diagnoses, four have rural designation and nine are small or medium metropolitan areas. NC’s HIV epidemic thrives alongside rising sexually transmitted infections (STI), which are also frequently concentrated in rural areas. Despite behavioral risk overlap of incident STIs and HIV, in NC, PrEP is only offered at a few, primarily urban health department (HD) affiliated STI clinics. The lack of robust healthcare infrastructure in rural areas, and persistent intersecting stigmas for YSGM of color, present unique challenges for HIV and STI prevention. Leveraging HD-affiliated STI clinics as an on-ramp to PrEP is an ideal opportunity to capitalize on STI service encounters and address disparities in YSGM’s PrEP access. A pathway to PrEP that utilizes existing clinic infrastructure to identify potential PrEP users, adapts services to ameliorate clinic constraints, and tailors PrEP engagement tools to specific client needs is a compelling strategy to improve PrEP access, uptake, and persistence in rural NC. This multilevel intervention to link PrEP and STI services, addresses barriers at policy, clinic, provider, and user levels. The strategy builds capacity and confidence via clinic training; facilitates patient handoff to navigators for linkage to financial support; and uses an evidence-based digital health platform, connecting users to peer educators, PrEP resources, and telehealth providers. The overarching objective is to parlay YSGM’s episodic STI service encounters into linkage to convenient, continuous PrEP care in NC. This objective will be accomplished in four aims. In Aim 1, investigators conduct a randomized trial at eight rural and peri-urban HD-affiliated STI clinics, enrolling YSGM into the above-described intervention or control based on enrolling clinic group assignment. The primary outcome is PrEP uptake within 3 months of clinic visit. In Aim 2, investigators conduct a cost-effectiveness analysis, including a budget impact analysis, examining cost per new PrEP initiation. If pre-defined go/no-go criteria are met, Aim 3 will proceed by engaging key stakeholders to refine the intervention, using an Intervention Mapping framework and informed by effectiveness outcomes and cost levers. Finally, in Aim 4, the refined intervention will be expanded to all eight clinics to examine impact on PrEP uptake and finalize cost estimates. If successful at increasing PrEP use and cost effective for increasing PrEP uptake and averting HIV infections, this intervention can be adapted for other populations and scaled up to STI clinics across NC and other rural and peri-urban areas in the US.

项目概要 改善暴露前预防 (PrEP) 的联系和采用对于结束艾滋病毒在该地区的流行至关重要 尽管 PrEP 的功效很高，但只有不到 20% 的符合 PrEP 资格的人接受了 PrEP 治疗。 2018 年，美国南部地区的处方率和接受率差距暴露了地区和种族差异。 北卡罗来纳州 (NC) 超过一半的新 HIV 诊断患者使用 PrEP，但只有三分之一的人使用 PrEP。 同样滞后，年轻性和性别少数群体（YSGM）的采用率最低，他们占 该州近三分之二的感染事件发生在北卡罗来纳州艾滋病毒感染率最高的县中。 诊断中，四个属于农村地区，九个属于北卡罗来纳州的中小都市地区。 随着性传播感染（STI）的增加而蓬勃发展，性传播感染也经常集中在农村 尽管性传播感染和艾滋病毒的行为风险重叠，但在北卡罗来纳州，仅在少数地区（主要是少数地区）提供 PrEP。 城市卫生部门 (HD) 附属性病诊所 农村地区缺乏健全的医疗基础设施， 以及对颜色 YSGM 持续存在的交叉耻辱，给艾滋病毒和性传播感染的预防带来了独特的挑战。 利用 HD 附属 STI 诊所作为 PrEP 的入口是利用 STI 服务的理想机会 遇到并解决 YSGM 的 PrEP 获取方面的差异 利用现有诊所的 PrEP 途径。 基础设施，以确定潜在的 PrEP 用户，调整服务以改善诊所的限制，并定制 PrEP 满足特定客户需求的参与工具是一项令人信服的策略，可改善 PrEP 的获取、采用和使用 这种将 PrEP 和 STI 服务联系起来的多层次干预措施在北卡罗来纳州农村地区的持续存在，解决了政策上的障碍， 该策略通过诊所培训促进能力和信心的建立； 将患者移交给导航器以获取财务支持，并使用基于证据的数字医疗； 平台，将用户与同伴教育者、PrEP 资源和远程医疗提供者联系起来。 目标是将 YSGM 的间歇性 STI 服务与方便、持续的 PrEP 联系起来 该目标将通过四个目标来实现。在目标 1 中，研究人员进行了一项随机试验。 在八个农村和城郊 HD 附属性传播感染诊所，将 YSGM 纳入上述干预措施或 基于入组临床分组的控制 主要结果是 3 个月内 PrEP 的吸收。 在目标 2 中，研究人员进行成本效益分析，包括预算影响分析， 如果满足预先定义的通过/不通过标准，目标 3 将通过参与进行。 主要利益相关者使用干预映射框架来完善干预措施，并通过 最后，在目标 4 中，精细化干预措施将扩展到所有八项。 诊所检查对 PrEP 使用的影响并最终确定成本估算（如果成功增加 PrEP 使用）和 这种干预措施对于增加 PrEP 的采用和避免 HIV 感染具有成本效益，可适用于其他 人口，并扩大到北卡罗来纳州以及美国其他农村和城郊地区的性传播感染诊所。