Characterizing the HIV pre-exposure prophylaxis care continuum for African American and Hispanic/Latino men who have sex with men

描述非裔美国人和男男性行为西班牙裔/拉丁裔男性的艾滋病毒暴露前预防护理连续性

• 批准号: 9410241
• 负责人: Philip Andrew Chan
• 金额: $ 78.04万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9410241
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; African American; Behavioral; Benchmarking; Bisexual; Blood; Caring; Categories; Clinical; Continuity of Patient Care; Data; Deep South; Development; Drops; Enrollment; Epidemic; Epidemiology; FDA approved; Future; Gays; Geographic Locations; Geography; HIV; HIV Infections; HIV diagnosis; Hispanics; Incidence; Individual; Intervention; Interview; Latino; Longitudinal cohort; Longitudinal cohort study; Measurement; Measures; Midwestern United States; Mississippi; Missouri; Modeling; Outcome; Patients; Population; Prospective cohort; Publishing; Rhode Island; Risk; Seasons; Site; Spottings; Testing; Time; United States; Ursidae Family; Visit; Work; base; behavior change; black men who have sex with men; burden of illness; clinical infrastructure; clinical research site; cohort; disparity reduction; experience; improved; inner city; men who have sex with men; pre-clinical; pre-exposure prophylaxis; prevent; primary outcome; programs; prospective; psychosocial; racial and ethnic disparities; retention rate; social; therapy design; transmission process; uptake

PROJECT SUMMARY Young African American (AA) and Hispanic/Latino (H/L) MSM bear a disproportionate share of the HIV disease burden in the United States (US). Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV acquisition risks among MSM, but its ability to reduce HIV acquisition among AA and H/L MSM hinges on optimal implementation and expanded use in “real-world” clinical settings. Preliminary studies demonstrate that AA and H/L initiate PrEP and are retained in PrEP care at lower rates than their White counterparts, but little is known about longer-term adherence and retention in PrEP care among AA and H/L MSM. The manner in which structural, social, and individual level factors impact PrEP outcomes in real-world settings, particularly among young AA and H/L MSM, are not yet well understood. MSM who initiate PrEP may change behaviors (e.g., enter a monogamous relationship with an HIV negative partner) and no longer be indicated for PrEP. Furthermore, it is largely unknown why individuals, especially AA and H/L MSM, are not retained in PrEP care which complicates development of appropriate interventions to enhance retention in PrEP care. This proposed study follows a longitudinal, observational cohort (n=450) of White, AA and H/L MSM in real-world PrEP programs in Mississippi, Missouri, and Rhode Island to both characterize a PrEP care continuum and predict why MSM are sub-optimally adherent or lost to care, with a focus on measuring racial and ethnic disparities (Specific Aim 1). We will conduct individual interviews with MSM who are prescribed PrEP but sub-optimally adherent or drop out of PrEP care (Specific Aim 2) to elucidate reasons for sub-optimal adherence and retention and to identify components of potential interventions to improve adherence and retention in care. Using data from our longitudinal cohort, we will perform microsimulations in the context of an agent-based model to evaluate the impact of sub-optimal PrEP adherence and retention in care on HIV incidence in three diverse US settings. We will then predict the impact of potential interventions on PrEP care continuum outcomes (Specific Aim 3).

项目摘要 年轻的非裔美国人（AA）和西班牙裔/拉丁美洲裔（H/L）MSM在艾滋病毒中占不变的份额 美国伯恩疾病（美国）。暴露前预防（PREP）在降低HIV方面非常有效 MSM的收购风险，但它减少AA和H/L MSM链式中艾滋病毒收购的能力 在“现实世界”临床环境中的最佳实施和扩展使用。初步研究表明 AA和H/L启动准备，并以比白色对应物低的速度保留预备护理，但几乎没有 已知有关AA和H/L MSM之间的长期依从性和保留率。方式 哪些结构，社会和个人层面因素会影响现实环境中的准备成果，特别是 在年轻的AA和H/L MSM中，尚不清楚。发起准备的MSM可能会改变行为 （例如，与艾滋病毒负面伴侣输入一夫一妻制的关系），不再指示准备。 此外，在很大程度上不知道为什么个人，尤其是AA和H/L MSM，并未保留在准备护理中 这使开发适当的干预措施复杂化，以增强预科护理中的保留率。这提出了 研究遵循现实世界准备中的白色，AA和H/L MSM的纵向观察队列（n = 450） 密西西比州，密苏里州和罗德岛州的节目既表征了预备连续性又可以预测 为什么MSM是次优的遵守或迷失的护理，重点是衡量种族和种族差异 （特定目标1）。我们将对开处方的MSM进行单独的访谈，但要优选 遵守或退出准备护理（特定目的2），以阐明次级遵守的原因和 保留并确定潜在干预措施的组成部分，以提高护理中的依从性和保留率。 使用我们纵向队列的数据，我们将在基于代理的背景下进行微模拟 评估次优的准备依从性和保留对护理对艾滋病毒入射的影响的模型 多样化的环境。然后，我们将预测潜在干预措施对预备护理连续体的影响 结果（特定目标3）。