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.

项目摘要 改善了预防前预防和摄取的联系对于结束HIV流行至关重要 美国（美国）。尽管Prep的效率很高，但只有不到20％的PREP资格的人收到了 摄取中的处方和差距暴露区域和种族分布。 2018年，美国南部占 在所有新的HIV诊断中，超过一半，但只有三分之一的PREP用户。北卡罗来纳州（NC）的准备 同样的滞后，在年轻性和性别少数群体（YSGM）中的吸收最低 该州近三分之二的事件感染。在艾滋病毒率最高的NC县中 诊断，四个具有粗糙的设计，九个是中小都会区。 NC的艾滋病毒流行 与性传播感染（STI）的增长繁殖，这些感染也经常集中在农村 区域。尽管行为风险与事件性传播感染和艾滋病毒的重叠重叠，但在北卡罗来纳州，PREP仅在少数几个中提供 城市卫生局（HD）会员STI诊所。农村地区缺乏强大的医疗基础设施， 并持续与YSGM颜色的污名相交，对HIV和STI预防提出了独特的挑战。 利用高清高清隶属性STI诊所作为坡度进行准备，是利用STI服务的理想机会 在YSGM的准备访问中遇到和解决差异。使用现有诊所的准备途径 基础架构以识别潜在的准备用户，适应服务改善诊所的约束，并裁缝准备 对特定客户需求的参与工具是一种令人信服的策略，可以改善准备访问，吸收和 北卡罗来纳州农村的持久性。这种多层次干预措施将PREP和STI服务联系起来，解决了政策的障碍， 诊所，提供商和用户级别。该策略通过诊所培训增强了能力和信心；促进 病人向导航员的交接，以与财务支持联系；并使用基于证据的数字健康 平台，将用户连接到同伴教育者，准备资源和远程医疗提供者。总体 目的是将YSGM的情节性STI服务与方便，连续的准备联系在一起 北卡罗来纳州的护理。这个目标将以四个目标来实现。在AIM 1中，调查人员进行了随机试验 在八个粗糙和城市高清附近的STI诊所，将YSGM纳入上述干预措施或 基于注册诊所组的控制。主要结果是在3个月内的预期吸收 诊所参观。在AIM 2中，调查人员进行了成本效益分析，包括预算影响分析， 检查每个新准备启动的成本。如果满足预定义的GO/NO-GO标准，AIM 3将通过参与 使用干预映射框架并通过 有效性结果和成本杠杆。最后，在AIM 4中，精致的干预措施将扩展到所有八个 诊所检查对准备的影响并确定成本估算的影响。如果成功增加了准备使用，并且 具有成本效益，可为增加摄取和避免艾滋病毒感染，可以适应其他干预措施 人口并扩展到美国北卡罗来纳州以及美国其他艰难和郊区地区的STI诊所。