Determining the effectiveness of a new model of PrEP initiation in Mississippi

确定密西西比州 PrEP 启动新模式的有效性

• 批准号: 10153506
• 负责人: Christine Mitra Khosropour
• 金额: $ 23.91万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-08 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10153506
• 关键词: AIDS prevention; Address; Age; Caring; Clinic; Clinical; Continuity of Patient Care; Data; Development; Diagnosis; Effectiveness; Epidemic; Ethnic Origin; Federal Government; Fill-It; Funding; Geographic state; Geography; Goals; HIV; HIV Infections; HIV Seronegativity; HIV diagnosis; Human immunodeficiency virus test; Incidence; Individual; Interview; Link; Maintenance; Measures; Medical; Methods; Mississippi; Modeling; Participant; Patients; Pharmacists; Population; Provider; Public Health; Race; Resources; Risk; Series; Site; Testing; Time; United States; United States National Institutes of Health; base; black men who have sex with men; clinical care; effectiveness evaluation; evidence base; high risk; innovation; men who have sex with men; personalized approach; pre-clinical; pre-exposure prophylaxis; preventive intervention; programs; prospective; racial disparity; ranpirnase; scale up; surveillance data; uptake

PROJECT SUMMARY/ABSTRACT The overall goal of this mixed-methods study is to examine the effectiveness of a same-day pre-exposure prophylaxis (PrEP) initiation program in Jackson, Mississippi, and to explore barriers and facilitators to PrEP initiation and retention in this model of PrEP delivery. HIV remains a critical public health problem in the United States (US), with minimal decreases in HIV incidence in the past five years. There are substantial disparities in HIV incidence and PrEP uptake in the US – by geography and race/ethnicity – that have persisted for decades. Mississippi is one of seven states identified by the federal Ending the HIV Epidemic (EHE) initiative as a “geographic hotspot” of HIV. MS has the sixth highest rate of new HIV diagnosis in the US, with the rate among Black Mississippians being eight times higher than White Mississippians. In 2018-2019 we initiated a pharmacist-led, same-day PrEP initiation program in Jackson to integrate same-day PrEP initiation at the time of HIV testing, with a goal of facilitating rapid increase of PrEP uptake in non-clinical settings in Jackson. Over 75% of individuals who were offered same-day PrEP filled the prescription and about half were linked into ongoing PrEP care. The program has continued operating with local funds, and new resources from the EHE could be leveraged to expand Rapid PrEP. However, gaps in the model's evidence base limit its scalability elsewhere. Here we propose a series of studies using prospective and retrospective data that will directly inform whether resources should be allocated to scaling-up Rapid PrEP or to developing alternative models of PrEP delivery. First, we will estimate the effectiveness of Rapid PrEP by examining PrEP persistence and HIV incidence among individuals who initiated PrEP via Rapid PrEP (N=121) compared to a group of individuals who initiated PrEP in a traditional “status quo” clinic-based model in Jackson, MS in 2015-2019 (N=475). We will use prescription fill data to compare the 12-month PrEP persistence between the two groups. In sub- analyses, we will restrict the population to those who were diagnosed with an STI after starting PrEP (a group at high ongoing risk of HIV) and compare PrEP persistence. We will also use MS State HIV surveillance data to compare HIV incidence between the two groups. Second, we will conduct 10-15 one-on-one qualitative interviews with Rapid PrEP participants who disengaged from PrEP care to investigate the barriers and facilitators to PrEP initiation and persistence. We will interview 3-4 Rapid PrEP participants who disengaged at each step of the Rapid PrEP continuum (e.g., filling the prescription, initial linkage to clinical care, and maintenance in PrEP care). Findings from these studies will direct the use of EHE resources to either scale-up Rapid PrEP or to develop new models of PrEP delivery that can be operationalized in settings of low clinical capacity.

项目总结/摘要 这项混合方法研究的总体目标是检查同一天预暴露的有效性 在密西西比杰克逊的预防（PrEP）启动计划，并探讨PrEP的障碍和促进因素 启动和保留在这种模式的PrEP交付。艾滋病毒仍然是美国一个严重的公共卫生问题。 在过去五年中，艾滋病毒发病率下降幅度最小的州（美国）。在以下方面存在着巨大的差异： 美国的艾滋病毒发病率和PrEP吸收率-按地理和种族/民族划分-已持续数十年。 密西西比州是联邦终止艾滋病毒流行（EHE）倡议确定的七个州之一。 艾滋病的“地理热点”。MS在美国的新艾滋病毒诊断率中排名第六， 密西西比黑人比白色密西西比人高八倍。在2018-2019年，我们发起了一个 在杰克逊由药剂师领导的当天PrEP启动计划，以整合当时的当天PrEP启动 艾滋病毒检测，目的是促进快速增加在杰克逊的非临床环境中的PrEP吸收。超过 75%的人谁提供了当天的PrEP填补了处方，约一半的人被链接到 持续的PrEP护理。该计划继续利用当地资金和EHE的新资源进行运作 然而，该模型的证据基础中的差距限制了其可扩展性 其他地方在这里，我们提出了一系列的研究，使用前瞻性和回顾性数据，将直接 告知是否应分配资源用于扩大快速PrEP或开发替代模型， PrEP递送。首先，我们将通过检查PrEP持续性和HIV来评估快速PrEP的有效性 与一组个人相比，通过快速PrEP启动PrEP的个人（N=121）的发病率 2015-2019年在MS的杰克逊以传统的“现状”诊所为基础的模式启动PrEP（N=475）。我们 将使用处方填充数据来比较两组之间12个月的PrEP持续性。在亚- 分析，我们将限制人口谁被诊断为性病后开始准备（一组） 艾滋病毒的高持续风险），并比较PrEP持久性。我们还将使用MS State HIV监测数据 比较两组的艾滋病发病率。第二，我们会进行10-15次一对一的定性 与快速PrEP参与者的访谈，他们脱离了PrEP护理，以调查障碍， 促进PrEP的启动和持续性。我们将采访3-4快速PrEP参与者谁脱离在 快速PrEP连续体的每个步骤（例如，填写处方，与临床护理的初步联系，以及 PrEP护理中的维护）。这些研究的结果将指导EHE资源的使用， 快速PrEP或开发新的PrEP提供模式，可在低临床风险环境中实施 容量