Strengthening the HIV prevention continuum using pharmacies

利用药房加强艾滋病毒预防连续性

基本信息

批准号：
10619854
负责人：
NATALIE D. CRAWFORD
金额：
$ 78.59万
依托单位：
EMORY 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：
2023-06-01 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10619854
关键词：
AIDS prevention Accounting Acquired Immunodeficiency Syndrome Adopted Adoption American Attitude Blood Pressure COVID-19 Cholesterol Client Collaborations Community Pharmacy Community Surveys Consolidated Framework for Implementation Research Counseling Development Effectiveness Engineering Epidemic Exploration, Preparation, Implementation, and Sustainment Glucose Goals HIV HIV Infections HIV Seronegativity HIV Seropositivity HIV diagnosis HIV risk Health Human immunodeficiency virus test Hybrids Individual Infection Interview Knowledge Methodology Methods Modeling Neighborhoods Persons Pharmacy facility Phase Policies Population Preparation Prevalence Prevention Primary Prevention Readiness Reporting Research Research Design Resources Risk Reduction Self Efficacy Service provision Services Source Stigmatization System Testing Training Treatment outcome United States Variant Viral Load result Work community engagement community transmission effectiveness outcome effectiveness testing effectiveness/implementation study experience health care availability high risk population hybrid type 1 design hybrid type 1 study implementation evaluation implementation outcomes implementation science member model development multidisciplinary online community patient safety phase 3 study pre-exposure prophylaxis prevent prevention service scale up screening service delivery service uptake social stigma testing access testing services testing uptake transmission process virtual willingness

项目摘要

ABSTRACT Early HIV diagnosis is an essential component of the strategy to End the HIV Epidemic (EHE). Yet, half of the nearly 40,000 Americans who test positive for HIV every year have late (stage 3 AIDS) infection, which results in higher community transmission and poorer treatment outcomes. In the United States South, where HIV is disproportionately impacted, 50% of HIV infections are undiagnosed. Infrequent or delayed HIV testing is most often due to poor healthcare access and stigmatizing attitudes about HIV that inhibit prevention and treatment seeking. Thus, increased HIV testing access and uptake is urgently needed to normalize HIV testing and direct individuals to pre-exposure prophylaxis (PrEP) if they test HIV negative or HIV treatment if they test HIV positive. To increase HIV testing access and uptake, we propose integrating HIV prevention services within community pharmacies located in neighborhoods with high HIV prevalence. Despite promising evidence of feasibility of pharmacy-based HIV testing, it is not widely available. In fact, most local pharmacy boards lack policy guidance on HIV testing being within their scope of practice. Our work has shown that HIV testing uptake in community pharmacies can be increased if it is offered with less stigmatized non-HIV-related services (e.g., COVID19, blood pressure, glucose, and cholesterol screening). But many community pharmacy staff report inadequate training as barriers to integrating HIV testing into the pharmacy work system. Therefore, to evaluate the implementation and effectiveness of HIV testing and prevention services within community pharmacies we propose a hybrid type 1 study design that aims to 1) Examine the policy-, pharmacy staff- and client-level barriers and facilitators of adopting HIV prevention services (e.g., HIV testing, PrEP referral, HIV treatment referral) in community pharmacies, 2) Develop and implement pharmacy staff HIV prevention service (e.g., HIV testing and counseling, PrEP referral, HIV treatment referral) trainings, and 3) Test the effects of integrating HIV prevention services in community pharmacies with existing non-HIV-related screenings versus those without on effectiveness and implementation outcomes. Guided by the Exploration, Preparation, Implementation, Sustainment framework, this study will include an exploration phase that examines the barriers and facilitators to pharmacy-based HIV prevention service provision across the US South using online surveys of community pharmacy staff (n=300), and in-depth interviews of Board of pharmacy members (n=16) and pharmacy staff (n=40). In the preparation phase, a virtual community pharmacy HIV prevention training will be developed and offered to 150 community pharmacy staff. Finally, in the implementation and sustainment phase, we will evaluate the acceptability and sustainment of the HIV prevention service delivery over 12 months in 10 community pharmacies (5 pharmacies who offer primary prevention screenings vs. 5 pharmacies who do not). Findings will be used to support scaling HIV prevention services in community pharmacies in the South where efforts to reduce HIV transmission are desperately needed to EHE.

抽象的早期HIV诊断是结束HIV流行（EHE）策略的重要组成部分。然而，一半每年近40,000名对HIV阳性阳性的美国人患有较晚（第三阶段艾滋病）感染，结果在更高的社区传播和较差的治疗结果中。在美国南部，艾滋病毒所在受不成比例的影响，50％的艾滋病毒感染未被诊断。最少或延迟的HIV测试是最多的通常是由于医疗保健的障碍和对hiv抑制预防和治疗的HIV的污名化寻求。因此，迫切需要增加HIV测试访问和吸收以使HIV测试正常化和直接如果个人测试HIV阴性或HIV治疗，则预防前预防前预防（PREP）积极的。为了增加艾滋病毒测试访问和吸收，我们建议整合艾滋病毒预防服务在艾滋病毒率高的社区中的社区药房内。尽管很有希望基于药房的艾滋病毒测试可行性的证据，并不广泛可用。实际上，大多数本地药房董事会缺乏有关艾滋病毒测试的政策指导，在其实践范围内。我们的工作表明艾滋病毒如果提供较少的非HIV相关的污名化，则可以增加社区药房的测试吸收服务（例如Covid19，血压，葡萄糖和胆固醇筛查）。但是许多社区药房员工报告不足以将艾滋病毒测试纳入药房工作系统的障碍。所以，评估社区内艾滋病毒测试和预防服务的实施和有效性药房我们提出了一种混合1型研究设计，目的是1）检查政策 - 药房工作人员和客户级障碍和采用艾滋病毒预防服务的促进者（例如，艾滋病毒测试，准备转诊，艾滋病毒社区药房中的治疗转诊），2）开发和实施药房人员预防艾滋病毒预防服务（例如，艾滋病毒测试和咨询，准备推荐，艾滋病毒治疗转诊）和3）测试将艾滋病毒预防服务与现有的非HIV相关筛查与现有的非HIV相关性相比那些没有效力和实施结果。在探索，准备工作的指导下实施，维持框架，本研究将包括一个探索阶段，该阶段检查在线使用在线的障碍和促进者，在整个美国南部的基于药房的艾滋病毒预防服务提供社区药房人员的调查（n = 300），以及药房成员的深入访谈（n = 16）和药房工作人员（n = 40）。在准备阶段，虚拟社区药房艾滋病毒预防培训将开发并提供给150名社区药房人员。最后，在实施中维持阶段，我们将评估艾滋病毒预防服务的可接受性和维持超过12个月的10个社区药店（提供主要预防筛查的5家药房与5 没有的药房）。调查结果将用于支持社区中的艾滋病毒预防服务南部的药房迫切需要减少艾滋病毒传播的努力。