PrEP uptake, adherence & retention for African American MSM in Mississippi

PrEP 的摄取、依从性

• 批准号: 9141506
• 负责人: Philip Andrew Chan
• 金额: $ 26.61万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-07 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9141506
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; African American; Age; Anti-Retroviral Agents; Appointment; Area; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical; Counseling; Deep South; Development; Elements; Enrollment; Epidemic; Evaluation; Feedback; Frequencies; Gays; Guidelines; HIV; HIV Infections; Health Insurance; Health Policy; Hearing; Incidence; Individual; Insurance; Insurance Coverage; Internet; Intervention; Interview; Learning; Life; Location; Medical; Mississippi; Modality; Participant; Patients; Pharmaceutical Preparations; Prevention; Preventive Intervention; Process; Prophylactic treatment; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Risk; Risk Reduction; Services; Sexual Partners; Social Policies; Staging; Structure; Tenofovir; Testing; Time; Transportation; Travel; Treatment Efficacy; United States; Visit; Writing; arm; base; condoms; copayment; cost; emtricitabine; experience; follow-up; high risk; improved; informant; meetings; men; men who have sex with men; patient assistance; payment; pill; prevention service; primary outcome; programs; public health relevance; sex risk; sexual encounter; social; social stigma; standard of care; therapy design; uptake; young men who have sex with men

 DESCRIPTION (provided by applicant): Young, African American men who have sex with men (YMSM) in the Deep South are disproportionately impacted by the HIV/AIDS epidemic. A once daily medication (emtricitabine/tenofovir) known as pre-exposure prophylaxis (PrEP) can dramatically reduce HIV acquisition among MSM but behavioral and social challenges undermine its optimal uptake, use and efficacy. This proposal by early stage investigators develops and tests a pilot intervention designed to enhance PrEP adherence and retention in care for AA YMSM in Mississippi. The findings of this research will be used to help define the essential elements of a prevention intervention to overcome barriers to PrEP adherence and retention in care among AA YMSM, and will be uniquely tailored to the social and health policy contexts relevant for African American men in the Deep South. In 2014, to respond to unmet need for HIV prevention services among AA MSM in the Deep South, our group established the first PrEP program in Jackson, Mississippi. Our clinical and implementation experience to date highlights several challenges and barriers that impede optimal PrEP adherence and retention in care for PrEP, and informed the following specific aims: Aim 1: Qualitative analyses will explore: 1) acceptability of improving PrEP uptake by engaging AA YMSM through mobile location-based phone and internet applications ("apps") (where nearly half of AA YMSM in Jackson, MS meet sexual partners); 2) sexual risk behaviors, including with partners met online vs. other venues, frequency of app use, and proportion of sexual encounters from specific geographical areas relative to where participants live; and 3) acceptability of potential intervention components and related content to support PrEP adherence and retention. Results will inform development of a context-specific, real-world PrEP intervention for AA YMSM in the South. Aim 2: To conduct an open pilot evaluation of the retain and adhere African American Men on PrEP (RAMP) intervention with up to 10 AA HIV-uninfected YMSM. Using an iterative process of implementation, feedback and continuing quality improvement over six months, we will improve acceptability and feasibility of this intervention. Aim 3: To conduct a pilot randomized control trial of the RAMP intervention among 80 AA HIV-uninfected YMSM. Participants will be randomized to either the RAMP intervention or a standard of care arm. The RAMP intervention will include patient assistance services for PrEP and related follow-up care, including: enhanced counseling, appointment reminders, assistance with overcoming insurance and other barriers to PrEP related services, and transportation assistance. Primary outcomes will include PrEP adherence and retention in PrEP related medical care.

 描述（由申请人提供）：在南方腹地发生性行为的年轻非裔美国男性 (YMSM) 受到艾滋病毒/艾滋病流行的影响尤为严重，这种药物每天一次（恩曲他滨/替诺福韦），称为暴露前预防（ PrEP）可以显着减少 MSM 中的 HIV 感染，但行为和社会挑战会破坏其最佳吸收、使用和功效。早期研究人员提出的这项提议开发并测试了旨在提高 PrEP 依从性的试点干预措施。密西西比州 AA YMSM 的护理和保留 这项研究的结果将用于帮助确定预防干预的基本要素，以克服 AA YMSM 坚持 PrEP 和保留护理的障碍，并将针对社会进行独特定制。 2014 年，为了满足南方腹地的 AA MSM 对艾滋病毒预防服务的未满足需求，我们小组在密西西比州杰克逊市建立了第一个 PrEP 项目。经验迄今为止，强调了阻碍 PrEP 最佳坚持和保留的几个挑战和障碍，并告知了以下具体目标： 目标 1：定性分析将探讨：1) 通过基于移动位置的 AA YMSM 参与来提高 PrEP 接受率的可接受性电话和互联网应用程序（“应用程序”）（密西西比州杰克逊市近一半的 AA YMSM 会见性伴侣）2) 性风险行为，包括在网上与其他场所认识的伴侣、应用程序使用频率和比例；与参与者居住地相关的特定地理区域的性接触情况；3) 支持 PrEP 坚持和保留的潜在干预内容和相关内容的可接受性，结果将为 AA YMSM 制定针对具体情况的现实 PrEP 干预措施提供信息。目标 2：对最多 10 名 AA HIV 未感染 YMSM 进行保留和坚持非裔美国男性 PrEP (RAMP) 干预的公开试点评估，采用实施、反馈和持续的迭代过程。通过六个月的质量改进，我们将提高该干预措施的可接受性和可行性 目标 3：在 80 名未感染 AA HIV 的 YMSM 中进行 RAMP 干预试点随机对照试验，参与者将被随机分配到 RAMP 干预组或标准组。 RAMP 干预措施将包括 PrEP 和相关后续护理的患者援助服务，包括：加强咨询、预约提醒、克服保险和 PrEP 相关服务的其他障碍的援助，以及交通援助。 PrEP 相关医疗护理中的 PrEP 依从性和保留率。