Integrated Rapid Access to HIV Prevention Program for People Who Inject Drugs (RAPID)

注射吸毒者综合快速艾滋病毒预防计划 (RAPID)

• 批准号: 10224917
• 负责人: Roman Shrestha
• 金额: $ 20.61万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224917
• 关键词: AIDS prevention; Address; Adherence; Adoption; Advanced Practice Nurse; Affect; Buprenorphine; Caring; Cessation of life; Client satisfaction; Clinic; Clinic Visits; Clinical; Communities; Complement; Counseling; Data; Development; Disease Outbreaks; Drug usage; Elements; Eligibility Determination; Epidemic; Evidence based program; Financial compensation; Future; Guidelines; HIV; HIV Infections; HIV risk; Harm Reduction; Health; Health Services Accessibility; Health education; Hospitalization; Injecting drug user; Injections; Interview; Judgment; Link; Logistics; Maintenance; Mental Health; Methadone; Modeling; Needle-Exchange Programs; Nurses; Opioid; Opioid agonist; Outcome; Overdose; Patients; Pharmaceutical Preparations; Physicians; Pilot Projects; Population; Prevention; Prevention program; Prevention strategy; Process; Provider; Public Health; Randomized Controlled Trials; Recommendation; Research; Resistance; Resources; Risk; Risk Behaviors; Safety; Services; Structure; Testing; Uncertainty; Underserved Population; United States; Visit; Vulnerable Populations; Wait Time; acceptability and feasibility; antiretroviral therapy; behavioral/social science; design; high risk; implementation framework; injection drug use; innovation; interest; men who have sex with men; novel strategies; opioid agonist therapy; opioid epidemic; patient oriented; pre-exposure prophylaxis; preference; prescription opioid; prevent; programs; response; scale up; screening; social interventions; substance use; success; therapy development; tool; transgender women; transmission process; treatment as usual; uptake

PROJECT SUMMARY The HIV epidemic among people who inject drugs (PWID) has been on the decline, but amidst a burgeoning opioid epidemic, communities are now increasingly vulnerable to HIV transmission. Recent HIV outbreaks linked to drug injection has introduced HIV into PWID networks and thus, potentially reverse decades of HIV prevention successes. While opioid agonist therapy (OAT) and syringe services programs (SSPs) reduce HIV transmission, access to and utilization of such programs are unavailable or with limited availability; sexual and injection-related HIV risks persist in many PWID. The integration of pre-exposure prophylaxis (PrEP) into existing evidence-based programs (e.g., OAT, SSPs) has been presented as an opportunity to strengthen HIV prevention efforts in PWID. Uptake, however, remains stubbornly low in PWID despite them being ideal candidates and interested in starting PrEP. Data from our ongoing PrEP adherence trial in PWID show high rates of attrition (43.7%) between the initial PrEP eligibility screening visit and PrEP initiation (usually 1-3 weeks). Further, qualitative interviews indicate preferences for PrEP delivery that would decrease waiting times or repeated visits altogether PrEP prescription. These early findings, supported by others, guide the need for rapid PrEP initiation integrated within an existing harm reduction services that reduce or eliminates patient, clinician, and structural barriers. Results from recent pilot studies have shown early acceptability, feasibility, and safety of rapid (same-day) PrEP initiation in men who have sex with men (MSM) and transgender women (TGW), but none of them include PWID, a group with extraordinary need in the current opioid crisis. Rapid PrEP initiation may be particularly important for PWID as they are more likely to be lost before treatment initiation. To fully optimize HIV prevention, PrEP care should be combined with OAT. Combining OAT with ART evolved from physicians who would withhold antiretroviral therapy (ART) from PWID if they were using drugs; if patients were OAT, ART prescription increased. Given the findings that advanced practice nurses (APNs) are more likely to inquire in a patient-centered manner about their drug use and provide more supportive counseling, a new differentiated care model of combined, same-day PrEP/OAT for PWID is well-suited to start with APNs. We, therefore, propose to develop and pilot test this model within an implementation science framework. The specific aims are to: 1) Aim 1: examine feasibility and acceptability among PWID and clinical stakeholders for an adapted APN-delivered, rapid HIV prevention program for PWID (iRaPID) that integrates same-day PrEP and OAT; and 2) Aim 2: estimate the preliminary efficacy of PrEP and OAT uptake in a pilot randomized controlled trial of the iRaPID vs. treatment as usual strategy in PWID without HIV. Together, these aims will address a wide gap in HIV prevention by addressing multilevel barriers to dispensing same-day combination prevention. Elements learned from a successful same-day PrEP/OAT model for PWID can guide future scale-up models that incorporate both APNs and physicians in urban and non-urban settings where resources are limited.

项目摘要 注射毒品（PWID）的人中的艾滋病毒流行正在下降，但在新兴 阿片类药物流行，社区现在越来越容易受到HIV传播的影响。最近的艾滋病毒爆发 与药物注射有关 预防成功。而阿片类药物激动剂疗法（OAT）和注射器服务计划（SSP）减少艾滋病毒 不可用的传输，访问和利用此类程序的可用性有限；性和 许多PWID中，与注射相关的艾滋病毒的风险持续存在。将暴露前预防（PREP）整合到 现有的基于证据的计划（例如，燕麦，SSP）已成为增强艾滋病毒的机会 PWID的预防努力。然而，尽管PWID是理想的，但吸收仍然固执 候选人和有兴趣开始准备。我们正在进行的PWID中正在进行的预备依从性试验的数据显示高率 初始准备资格筛选访问和准备启动（通常为1-3周）之间的损耗（43.7％）。 此外，定性访谈表明对准备交付的偏好将减少等待时间或 重复访问完全准备处方。这些早期发现得到了其他人的支持，指导了快速的需求 集成在现有减少危害服务中的准备启动，以减少或消除患者，临床医生， 和结构性障碍。最近的试点研究的结果表明，早期的可接受性，可行性和安全性 与男性发生性关系（MSM）和变性妇女（TGW）的男性的快速（当天）准备启动（TGW） 它们都不包括PWID，PWID是当前阿片类药物危机中非常需要的小组。快速准备启动 对于PWID来说，可能尤其重要，因为它们在治疗开始之前更有可能丢失。完全 优化预防艾滋病毒，应与燕麦进行准备。将燕麦与艺术结合起来 如果使用药物，将从PWID中扣留抗逆转录病毒疗法（ART）的医生；如果患者 是燕麦，艺术处方增加。考虑到高级实践护士（APN）的发现更有可能 以患者为中心的毒品使用并提供更多支持性咨询，这是一个新的 合并的差异化护理模型，用于PWID的当天准备/燕麦非常适合从APN开始。我们， 因此，建议在实施科学框架内开发和试点测试此模型。具体 目的是：1）目标1：检查PWID和临床利益相关者之间的可行性和可接受性 适用于PWID（IRAPID）的适应APN的APN转换，快速HIV预防计划（IRAPID） 和燕麦;和2）目标2：估计飞行员随机摄取PrEP和OAT的初步功效 IRAPID与惯例的对照试验在没有HIV的PWID中。这些目标将在一起 通过解决分配当天组合的多层次障碍，解决艾滋病毒预防的巨大差距 预防。从成功的当天准备/燕麦模型中学到的元素可以指导未来的扩展 在资源有限的城市和非城市环境中纳入APN和医生的模型。