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.

抽象的早期艾滋病毒诊断是终结艾滋病毒流行 (EHE) 战略的重要组成部分。然而，一半的每年有近 40,000 名 HIV 检测呈阳性的美国人患有晚期（艾滋病第 3 阶段）感染，这导致社区传播率较高，治疗结果较差。在美国南部，艾滋病毒高发地区 50% 的艾滋病毒感染者未得到诊断，所受影响尤为严重。不频繁或延迟进行 HIV 检测是最常见的通常是由于医疗保健服务条件差和对艾滋病毒的污名化态度阻碍了预防和治疗寻求。因此，迫切需要增加艾滋病毒检测的可及性和采用率，以使艾滋病毒检测正常化并指导艾滋病毒检测如果检测出 HIV 呈阴性，则进行暴露前预防 (PrEP)；如果检测出 HIV，则进行 HIV 治疗积极的。为了增加艾滋病毒检测的可及性和采用率，我们建议整合艾滋病毒预防服务位于艾滋病毒感染率高的社区的社区药房内。尽管有希望尽管有证据表明基于药房的艾滋病毒检测的可行性，但尚未广泛使用。事实上，大多数本地药房委员会缺乏关于其实践范围内的艾滋病毒检测的政策指导。我们的工作表明，艾滋病毒如果社区药房提供的检测与非艾滋病毒相关的污名较少，则可以增加检测的采用率服务（例如，新冠肺炎、血压、血糖和胆固醇筛查）。但很多社区药房工作人员报告说，培训不足是将艾滋病毒检测纳入药房工作系统的障碍。所以，评估社区内艾滋病毒检测和预防服务的实施情况和有效性我们提出了一种混合 1 型研究设计，旨在 1) 检查政策、药房工作人员和客户层面采用 HIV 预防服务的障碍和促进因素（例如 HIV 检测、PrEP 转诊、HIV 治疗转诊）在社区药房，2）制定和实施药房工作人员艾滋病毒预防服务（例如，HIV 检测和咨询、PrEP 转诊、HIV 治疗转诊）培训，以及 3) 测试效果将社区药房的艾滋病毒预防服务与现有的非艾滋病毒相关筛查相结合那些没有有效性和实施结果的人。以探索、准备为指导，实施、维持框架，本研究将包括一个探索阶段，检查在美国南部使用在线方式提供基于药房的艾滋病毒预防服务的障碍和促进因素对社区药房工作人员的调查（n=300），对药房委员会成员的深度访谈（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 名社区药房工作人员。最后，在实施和在维持阶段，我们将评估艾滋病毒预防服务提供的可接受性和维持性在 10 个社区药房（5 个提供初级预防筛查的药房 vs. 5 个药店没有）。研究结果将用于支持扩大社区艾滋病毒预防服务南方的药房迫切需要 EHE 努力减少艾滋病毒传播。