RP1 Screen 2 Prevent

RP1 屏蔽 2 预防

基本信息

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
项目类别：
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

项目摘要

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.

项目概要在美国，青少年 (AYA) 受艾滋病毒影响尤为严重。尽管正值青春期占新感染人数的 20% 以上，这个年龄组是最不可能接受艾滋病毒检测的，这与护理有关，与成人相比，实现病毒抑制。此外，AYA 的艾滋病毒感染率也很低暴露前预防 (PrEP) 的认识和采用。因此，迫切需要扩大艾滋病毒针对非传统医疗机构（例如急诊科 (ED)）的筛查和预防策略联系 AYA，否则他们将无法获得预防性医疗保健。该应用程序的目标是利用我们最近从多中心、基于急诊室的青少年淋病和衣原体获得的见解筛选研究以确定最具临床意义和成本效益的 AYA HIV 筛查方法，该方法将还对高危青少年使用数字健康和快速启动 PrEP 或抗逆转录病毒治疗 (ART)。这将是通过艾滋病毒/艾滋病干预青少年医学试验网络 (ATN) 通过利用其基础设施包括地理位置不同的站点联盟，包括青少年诊所及其相关儿科急诊室。这项研究将为创造临床有效、具有成本效益且可持续的艾滋病毒筛查计划，可以成功地实施到临床中急诊室的工作流程。它还将改善对高危青少年的 PrEP/ART 护理的识别和联系使用移动医疗策略，首先根据 AYA 对 PrEP/ART 候选者的反应来识别他们计算机化性健康筛查（cSHS），并随后提供临床决策支持（CDS）提供者通过电子健康记录和教育信息直接通过短信发送至 PrEP/ART 候选人根据他们的艾滋病毒结果。这种干预将依赖于一种创新的方法，该方法以电子方式整合患者报告的数据来指导 CDS。这项工作意义重大，因为它有可能填补以下方面的空白：文献需要为儿科急诊室中艾滋病毒筛查的最佳方法提供证据。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（仅筛查那些披露高风险性行为）与普遍提供的艾滋病毒筛查（选择加入和选择退出方法通过电子集成患者报告的数据以提供 CDS 和确定 PrEP 候选资格。根据艾滋病毒检测结果，我们将利用数字健康来实现状态中立快速或当天移动医疗 PrEP/ART 启动 (SMART) 并与护理联系起来。这项研究的新颖之处在于它改变了儿科急诊科 HIV 筛查和预防的常用临床实践范式采取一致和可持续的方法，这对于解决 AYA 中的艾滋病毒流行问题至关重要。