Delivery of integrated PrEP and ART for HIV prevention for couples in Kenya

为肯尼亚夫妇提供综合 PrEP 和 ART 预防艾滋病毒

• 批准号: 10158924
• 负责人: Jared Baeten
• 金额: $ 14.71万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-10 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10158924
• 关键词: AIDS prevention; Adherence; Administrative Supplement; Africa; African; Blood specimen; COVID-19; COVID-19 pandemic; Caring; Client; Clinic; Collaborations; Communities; Complex; Contacting Client; Couples; Data; Data Collection; Distress; Emergency Situation; Enrollment; Experimental Designs; Foundations; Funding; Goals; HIV; HIV Infections; HIV-1; Health; Health Personnel; Health care facility; Health system; Hearing; Human immunodeficiency virus test; Incidence; Individual; Infrastructure; Interruption; Interview; Kenya; Methods; Modeling; Monitor; Motivation; Nurses; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Prevention; Process; Provider; Public Health; Randomized; Records; Service provision; Services; System; Telephone; Tenofovir; Time; Time Series Analysis; Time and Motion Studies; Training; Work; base; cost; cost effectiveness; experience; implementation science; innovation; mathematical model; novel; pre-exposure prophylaxis; programs; public health emergency; randomized trial; resilience; scale up; service delivery; standard care; success; tool; trial design; uptake

ABSTRACT Maximizing access is one of the key challenges for optimizing the public health impact of pre-exposure prophylaxis (PrEP) for HIV prevention. The coronavirus disease 2019 (COVID-19) epidemic has overwhelmed health systems globally. In Africa, PrEP has been added to an already-burdened health infrastructure, and the overlay of COVID-19 threatens derail the tremendous progress made with HIV treatment and prevention, including provision of PrEP. Since 2017, in collaboration with the Kenyan Ministry of Health, we have been conducting a large step-wedge randomized roll-out of PrEP delivery in 24 high-volume, PEPFAR-supported, public HIV care facilities, using detailed data abstraction from clinic records and implementation science methods (including the RE-AIM framework), plus training and technical assistance in another ~70 clinics outside of the randomized trial (together, the work is called the Partners Scale-Up Project). We have found high enthusiasm among providers and clients, with good uptake, continuation, and adherence for PrEP and clinic-initiated adaptions that may PrEP delivery more efficient. During the current COVID-19 emergency, we have continued remote provision of technical assistance to monitor implementation progress and cross-pollinate best practices across clinics. We are hearing that health providers feel ill-prepared to manage or screen for COVID-19 but nevertheless remain committed to serving clients. Clinics have rapidly accelerated adaptations to continue services provision, including dispensing longer PrEP refills, quickly initiating one-stop provision of PrEP services (to minimize staff-client contact), and shifting PrEP services to HIV testing centers and potentially to community- based delivery. Incredibly, PrEP initiations/refills are continuing at a rate similar to 2019. Thus, we hypothesize that despite the alarming implications for individuals and health systems of the COVID-19 emergency, there is both resilience of public health clinic staff and opportunity for health systems to adapt and innovate efficient strategies for provision of critical services. In this administrative supplement, we propose to add a novel aim (Aim 5) to explore the impact of COVID-19 on PrEP services, specifically clinic adaptation and staff resilience. We propose to document and accelerate rapid adaptations in PrEP services across the ~100 clinics across Kenya in our network, using our technical assistance model to cross-pollinate best practices that mitigate COVID-19 impacts. Qualitative interviews will explore provider distress and identify key components of resilience and PrEP service adaptation. The work is fully within the scope of our ongoing project, which has explicit goals of understanding barriers and facilitating innovations for PrEP delivery for providers and health systems. Given our robust technical assistance network and data collection systems (including phone/video interviews), this work can begin immediately and will be translatable to PrEP delivery across Africa during this public health emergency.

抽象的 最大限度地提高接触机会是优化预暴露对公共卫生影响的关键挑战之一 预防艾滋病毒 (PrEP)。 2019 年冠状病毒病 (COVID-19) 疫情已不堪重负 全球卫生系统。在非洲，PrEP 已被添加到已经不堪重负的卫生基础设施中，并且 COVID-19 的叠加可能会破坏艾滋病毒治疗和预防方面取得的巨大进展， 包括提供 PrEP。自 2017 年以来，我们与肯尼亚卫生部合作， 在 PEPFAR 支持的 24 个大批量、 公共艾滋病毒护理设施，使用从临床记录中提取的详细数据和实施科学方法 （包括 RE-AIM 框架），以及在其他约 70 家诊所提供的培训和技术援助 随机试验（这项工作统称为合作伙伴扩大项目）。我们发现了很高的热情 在提供者和客户中，对 PrEP 和诊所发起的治疗有良好的接受度、持续性和依从性 可以更有效地进行 PrEP 交付的调整。在当前的 COVID-19 紧急情况下，我们继续 远程提供技术援助，以监测实施进度并传播最佳实践 跨诊所。我们听说医疗服务提供者感觉没有做好管理或筛查 COVID-19 的准备，但 尽管如此，仍然致力于为客户提供服务。诊所已迅速加速适应以继续 服务提供，包括配发更长的PrEP补充液，快速启动一站式提供PrEP服务 （以尽量减少工作人员与客户的接触），并将 PrEP 服务转移到 HIV 检测中心，并可能转移到社区 - 基于交付。令人难以置信的是，PrEP 启动/补充的速度与 2019 年相似。因此，我们假设 尽管 COVID-19 紧急情况对个人和卫生系统产生了令人震惊的影响，但 公共卫生诊所工作人员的适应能力和卫生系统高效适应和创新的机会 提供关键服务的战略。在这个行政补充中，我们建议添加一个新的目标（Aim 5) 探讨 COVID-19 对 PrEP 服务的影响，特别是诊所适应和员工适应能力。我们 建议记录并加速肯尼亚约 100 家诊所的 PrEP 服务的快速调整 在我们的网络中，使用我们的技术援助模型来交叉传播缓解 COVID-19 的最佳实践 影响。定性访谈将探讨提供者的困境并确定恢复力和 PrEP 的关键组成部分 服务适配。这项工作完全在我们正在进行的项目的范围内，该项目有明确的目标 了解为提供者和卫生系统提供 PrEP 的障碍并促进创新。鉴于我们的 强大的技术援助网络和数据收集系统（包括电话/视频采访），这项工作 可以立即开始，并将在这次公共卫生紧急情况下应用于整个非洲的 PrEP 交付。

项目成果

Using plasma viral load to guide antiretroviral therapy initiation to prevent HIV-1 transmission.

使用血浆病毒载量指导抗逆转录病毒治疗的启动，以预防 HIV-1 传播。

• 发表时间: 2012
• 影响因子: 3.7
• 作者: Murnane, Pamela M;Hughes, James P;Celum, Connie;Lingappa, Jairam R;Mugo, Nelly;Farquhar, Carey;Kiarie, James;Wald, Anna;Baeten, Jared M;Partners in Prevention HSV/HIV Transmission Study Team
• 通讯作者: Partners in Prevention HSV/HIV Transmission Study Team

Preexposure prophylaxis for HIV prevention: where have we been and where are we going?

预防艾滋病毒的暴露前预防：我们去过哪里，要去哪里？

• 发表时间: 2013-07
• 作者: Baeten, Jared M;Haberer, Jessica E;Liu, Albert Y;Sista, Nirupama
• 通讯作者: Sista, Nirupama

Welcome to the preexposure prophylaxis revolution.

欢迎来到暴露前预防革命。

• 发表时间: 2016-01
• 作者: Baeten, Jared;McCormack, Sheena
• 通讯作者: McCormack, Sheena

The preexposure prophylaxis revolution; from clinical trials to programmatic implementation.

暴露前预防革命；

• 发表时间: 2016-01
• 作者: Mugo, Nelly R;Ngure, Kenneth;Kiragu, Michael;Irungu, Elizabeth;Kilonzo, Nduku
• 通讯作者: Kilonzo, Nduku

Feasibility and acceptability of HIV self-testing among pre-exposure prophylaxis users in Kenya.

肯尼亚暴露前预防使用者进行艾滋病毒自我检测的可行性和可接受性。

• 发表时间: 2017-02-10
• 影响因子: 6
• 作者: Ngure, Kenneth;Heffron, Renee;Mugo, Nelly;Thomson, Kerry A;Irungu, Elizabeth;Njuguna, Njambi;Mwaniki, Lawrence;Celum, Connie;Baeten, Jared M
• 通讯作者: Baeten, Jared M