RP1 Screen 2 Prevent

RP1 屏蔽 2 预防

• 批准号: 10595901
• 负责人: Lisa B Hightow-Weidman
• 金额: $ 91.51万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-25 至 2029-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595901
• 关键词: AIDS prevention; Accident and Emergency department; Accounting; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent; Adolescent Medicine Trials Network; Adolescent and Young Adult; Adult; Affect; Applied Research; Awareness; Behavior; Caring; Centers for Disease Control and Prevention (U.S.); Chlamydia; Clinic; Clinical; Clinical effectiveness; Collection; Consensus; Data; Data Reporting; Diagnosis; Electronic Health Record; Electronics; Emergency Care; Emergency department visit; Epidemic; Geographic Locations; Geography; Goals; Gonorrhea; HIV; HIV Infections; HIV/AIDS; Health Status; Health Technology; Health education; Healthcare; Hour; Human immunodeficiency virus test; Infection; Infection prevention; Infrastructure; Intervention; Leadership; Link; Literature; Location; Logistics; Methods; Modeling; Outcome; Patient Outcomes Assessments; Patients; Persons; Population; Prevention; Prevention strategy; Preventive healthcare; Primary Care; Provider; Recommendation; Research; Risk; Risk Assessment; Risk Factors; Sexual Health; Site; System; Test Result; Text Messaging; Translating; United States; Viral; Work; Youth; age group; antiretroviral therapy; behavior change; candidate identification; clinical decision support; clinical practice; comparative effectiveness trial; computed tomography screening; computerized; cost; cost effective; cost effectiveness; design; digital health; digital healthcare; evidence base; health care settings; high risk; high risk sexual behavior; improved; innovation; insight; mHealth; novel; pediatric emergency; pragmatic trial; pre-exposure prophylaxis; prevent; primary care services; response; screening; screening program; stem; success; telehealth; treatment adherence; uptake

PROJECT SUMMARY Adolescents and young adults (AYA) are disproportionately affected by HIV in the US. Despite adolescents accounting for over 20% of new infections, this age group is the least likely to be tested for HIV, linked to care, and achieve viral suppression as compared to their adult counterparts. Further, AYA also have low rates of HIV Pre-Exposure Prophylaxis (PrEP) awareness and uptake. Therefore, there is an urgent need to expand HIV screening and prevention strategies to nontraditional healthcare settings such as emergency departments (ED) to reach AYA who would otherwise not receive preventive healthcare. The goal of this application is to leverage our recent insights obtained from a multi-center, ED-based, adolescent gonorrhea and chlamydia screening study to determine the most clinically and cost-effective HIV screening approach for AYA that will also use digital health and rapid start PrEP or antiretroviral therapy (ART) for at risk youth. This will be accomplished through the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) by leveraging its infrastructure which includes geographically diverse site consortiums including adolescent clinics and their associated pediatric EDs. This research will contribute to the evidence base for creating clinically effective, cost-effective, and sustainable HIV screening programs that can be successfully implemented into the clinical workflow of the ED. It will also improve identification and linkage to PrEP/ART care for at risk adolescents using mHealth strategies by first identifying AYA who are PrEP/ART candidates based on their responses to a computerized sexual health screen (cSHS) and subsequently providing clinical decision support (CDS) to providers via the electronic health record and educational information by text message directly to PrEP/ART candidates based on their HIV results. This intervention will rely on an innovative approach that electronically integrates patient-reported data to guide CDS. This work is significant because it has the potential to fill gaps in the literature needed to provide evidence for the best method of HIV screening in a pediatric ED setting. First, we will conduct a pragmatic comparative effectiveness trial of targeted HIV screening (screening only those disclosing high risk sexual behavior) versus universally offered HIV screening (both opt-in and opt-out methods offered to all, regardless of risk) through electronic integration of patient reported data for provision of CDS and identification of PrEP candidacy. Based on HIV test results, we will then harness digital health for status neutral rapid or same-day mHealth PrEP/ART start (SMART) and linkage to care. This research is novel in that it shifts the usual clinical practice paradigm of HIV screening and prevention in the pediatric ED from a scattered approach to a consistent and sustainable approach that is critical to addressing the HIV epidemic among AYA.

项目摘要 在美国，青少年和年轻人（AYA）受艾滋病毒的影响不成比例。尽管青少年 该年龄组占新感染的20％以上，对艾滋病毒的测试最少，与护理有关 与成人相比，并获得病毒抑制。此外，AYA的艾滋病毒率也很低 暴露前预防（PREP）意识和吸收。因此，迫切需要扩大艾滋病毒 筛查和预防策略为非传统医疗保健设置，例如急诊科（ED） 到达否则不会获得预防保健的Aya。该应用的目的是 利用我们最近从多中心，基于ed，青少年淋病和衣原体获得的见解 筛查研究以确定AYA上最临床和成本效益的HIV筛查方法 还使用数字健康和快速起步PREP或抗逆转录病毒疗法（ART），以应对年轻人。这将是 通过利用艾滋病毒/艾滋病干预措施（ATN）的青少年医学试验网络完成 它的基础设施，其中包括各种地理上的地点财团，包括青少年诊所及其 相关的小儿ED。这项研究将有助于创造临床有效的证据基础 具有成本效益和可持续的HIV筛查计划，可以成功实施临床 ED的工作流程。它还将改善身份识别和联系，以应对青少年的危险/艺术护理 首先根据对A的反应来使用MHealth策略。 计算机化性健康屏幕（CSHS），随后提供临床决策支持（CD） 通过电子健康记录和教育信息提供给提供者，直接通过短信到准备/艺术 候选人基于他们的HIV结果。这种干预将依赖于电子上的创新方法 集成患者报告的数据以指导CD。这项工作很重要，因为它有可能填补空白 文献需要为儿科环境中最佳的艾滋病毒筛查方法提供证据。第一的， 我们将对有针对性的艾滋病毒筛查进行务实的比较有效性试验（仅筛查这些试验 披露高风险性行为）与普遍提供的艾滋病毒筛查（选择加入和退出方法 通过电子整合患者报告的数据提供CD和 识别准备候选资格。基于艾滋病毒测试结果，我们将利用数字健康状态保持状态中性 快速或当天的MHealth Prep/Art Start（SMART）和与Care的联系。这项研究是新颖的，因为它发生了变化 艾滋病毒筛查和预防的通常的临床实践范式来自分散的儿科。 采用一致和可持续的方法，这对于解决AYA之间的艾滋病毒流行至关重要。