Improving the HIV PrEP Cascade using an Intervention for Healthcare Providers

使用医疗保健提供者干预措施改善 HIV PrEP 级联

• 批准号: 9568027
• 负责人: Parya Saberi
• 金额: $ 76.47万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9568027
• 关键词: AIDS prevention; Address; Adherence; Adult; Appointment; Awareness; Behavioral; Benefits and Risks; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinic; Clinical; Continuity of Patient Care; Data; Education; Ensure; Ethnic Origin; Formulation; Gender; Goals; HIV; HIV risk; Health Personnel; Individual; Intervention; Interview; Knowledge; Laboratories; Monitor; Online Systems; Outcome; Patient risk; Patients; Phase; Population; Prevention strategy; Primary Health Care; Privatization; Provider; Public Health; Race; Randomized Clinical Trials; Recommendation; Recording of previous events; Registries; Reporting; Research; Resources; Risk; Risk Assessment; Role; San Francisco; Schedule; Sexually Transmitted Diseases; Speed; Standardization; Structure; Surveys; System; Test Result; Testing; Time; Training; Visit; base; dashboard; design; early experience; experience; follow-up; high risk; improved; innovation; interest; knowledge base; novel; pre-exposure prophylaxis; response; sex; support tools; tool; uptake; willingness

Abstract/Project Summary: HIV pre-exposure prophylaxis (PrEP) has been shown to be highly effective for HIV prevention in randomized clinical trials but uptake of PrEP in the U.S. has been limited. One of the barriers to PrEP implementation is lack of healthcare provider (HCP) knowledge and willingness to prescribe it. As outcomes of current PrEP formulations in real-world settings and different populations are reported and novel PrEP formulations are introduced, HCPs will continue to require support and guidance to optimize the clinical and public health impact of this valuable HIV prevention strategy. We propose a PrEP optimization intervention targeted at HCPs to increase PrEP uptake and persistence among those at risk for HIV acquisition. This intervention includes: (1) an integrated web-based panel management tool called PrEP-Rx, which provides structured HIV risk assessment, automates reminders for laboratory testing and appointments, and reports patients' history of PrEP use; and (2) a centralized PrEP coordination overseen by a clinical support staff (referred to as the PrEP coordinator) who can identify individuals at high risk for HIV through direct patient contact or by reviewing registries for sexually transmitted infections (STIs) and who can support multiple HCPs. We propose the following aims: Primary Aim: Evaluate the efficacy of the PrEP optimization intervention (PrEP Coordinator + PrEP-Rx) to increase PrEP prescriptions through a stepped-wedge design among 10 primary care clinics. We hypothesize that the mean number of prescriptions issued will be significantly higher when the clinics use the PrEP intervention versus when they do not. Secondary Aims: 1- Explore differences in PrEP initiation, duration of use, and reasons for discontinuation based on patient's age, race/ethnicity, and sex/gender, and by clinic and HCP characteristics among study clinics. 2- Explore sustainability of the intervention during an eight-month follow-up after the stepped-wedge Phase. 3- Investigate facilitators and barriers of PrEP delivery and experiences with the proposed PrEP intervention through qualitative interviews with HCPs, PrEP Coordinators, and clinic directors of study clinics. The combination of the PrEP Coordinator plus PrEP-Rx has the potential to improve all steps of the PrEP continuum and enhance overall care by identifying individuals at high risk of HIV acquisition, standardizing HIV risk assessment, helping in PrEP initiation, systematizing follow-up visits or laboratory assessments, and educating HCPs about emerging PrEP data. These goals can have a significant public health impact and be attained with minimal burden on existing clinic resources. We are using innovative approaches for PrEP delivery which will result in training of HCPs to increase the number of HCPs capable of offering PrEP. Ultimately, the proposed research has the potential to reduce gaps in the PrEP cascade.

摘要/项目摘要： HIV暴露前预防（PREP）已被证明对预防HIV预防非常有效 在美国的随机临床试验，但PREP的吸收受到限制。准备的障碍之一 实施是缺乏医疗保健提供者（HCP）知识和开处方的意愿。作为结果 报告现实环境中的当前准备配方和不同的种群和新的准备 引入配方，HCP将继续需要支持和指导，以优化临床和 这种宝贵的艾滋病毒预防策略的公共卫生影响。我们提出了准备优化干预 针对HCP的目标是增加有艾滋病毒收购风险的人的预备摄取和持久性。这 干预包括：（1）一种基于Web的集成面板管理工具，称为Prep-Rx，该工具提供 结构化的艾滋病毒风险评估，自动提醒实验室测试和任命，并报告 患者的准备史； （2）由临床支持人员监督的集中准备协调 （称为预备协调员）可以通过直接患者识别出艾滋病毒高风险的人 联系或通过审查性传播感染（STI）并可以支持多个HCP的注册表。 我们提出以下目标： 主要目的：评估准备优化干预措施（PrepSodinator + Prep-Rx）的功效 通过10个初级保健诊所中的跨斜向设计增加预处方。我们假设 当诊所使用PREP时 干预与不进行干预。 次要目的： 1-探讨根据患者的准备启动，使用时间的差异以及中断的原因 年龄，种族/种族以及性别/性别，以及研究诊所的诊所和HCP特征。 2-探讨在阶梯末期的八个月随访中的干预措施的可持续性。 3-调查提议交付和经验的促进者和拟议的准备干预措施的障碍 通过与HCP，Prep协调员和研究诊所的诊所主管的定性访谈。 预备协调器加Prep-Rx的组合有可能改善所有步骤 通过确定艾滋病毒收购高风险的个人，预先策略和增强整体护理， 标准化艾滋病毒风险评估，有助于准备启动，系统化后续访问或实验室 评估，并教育HCP有关新兴准备数据。这些目标可以有重要的公众 健康影响，并承担现有诊所资源的最小负担。我们正在使用创新 准备交付的方法将导致训练HCP，以增加HCP的数量 提供准备。最终，拟议的研究有可能减少准备级联的差距。