Differentiated interventions to support HIV PrEP persistence in patients with substance use

支持药物滥用患者持续进行 HIV PrEP 的差异化干预措施

• 批准号: 10159173
• 负责人: Jose Carlo Glang Hojilla
• 金额: --
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2021-10-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10159173
• 关键词: AIDS prevention; Address; Adherence; Alcohols; Awareness; Behavior Therapy; Biological Markers; California; Caring; Characteristics; Clinic; Clinical; Clinical Data; Counseling; Data; Development; Drug usage; Educational Intervention; Electronic Health Record; Epidemic; Funding; Future; Goals; Grant; Growth; HIV; HIV Infections; HIV risk; Health Benefit; High Prevalence; Incidence; Individual; Integrated Delivery of Health Care; Intervention; Interview; Lead; Literature; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; National Institute of Drug Abuse; Outcome; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Population Study; Populations at Risk; Predictive Factor; Prevention strategy; Protocols documentation; Public Health; Qualitative Methods; Qualitative Research; Randomized Clinical Trials; Research; Research Methodology; Research Personnel; Research Priority; Research Training; Risk; Sampling; San Francisco; Subgroup; System; Technology; Testing; Time; Training; Treatment outcome; United States National Institutes of Health; Universities; Work; acceptability and feasibility; alcohol misuse; alcohol use disorder; base; care delivery; career; cohort; efficacy trial; evidence base; falls; health care delivery; high risk drinking; improved; insight; medication compliance; men who have sex with men; multidisciplinary; oral HIV; personalized intervention; pre-exposure prophylaxis; preference; programs; screening; stimulant use; substance use; transgender; uptake

ABSTRACT/PROJECT SUMMARY Dr. Hojilla's long-term career goal is to become an independently funded investigator with expertise in HIV prevention and precision behavioral interventions to optimize biomedical prevention strategies, like pre- exposure prophylaxis (PrEP), in populations with substance use (SU). PrEP is a key pillar of the Ending the Epidemic Initiative and although uptake is increasing, the high rates of PrEP discontinuation threaten its public health impact. SU, including drug and unhealthy alcohol use, are well-established predictors of HIV risk and presents an overlapping vulnerability for poor adherence and poor retention in care. Early PrEP discontinuation is a key predictor of subsequent HIV infection, but few persistence interventions exist, particularly for individuals with SU. Differentiated interventions, where efforts are adapted based on individual needs, have shown promising findings in the HIV treatment literature, but have not been evaluated in the context of PrEP. Using the ADAPT-ITT framework, the overall objective of this K23 application is to adapt existing evidence- based adherence strategies to develop differentiated PrEP persistence interventions in populations with SU. The study will leverage a large, clinic-based cohort of PrEP patients in Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system. Aim 1 will estimate individual growth trajectories to identify latent patterns (classes) of PrEP persistence. We will evaluate predictors of each class and compare differences in patterns of PrEP use between patients with and without SU. Understanding the patterns by which patients use PrEP over time and the characteristics that predict problematic patterns of PrEP use will allow us to distinguish individuals who require intervention and evaluate what interventions will work best for a given subgroup. In Aim 2, patients with SU from the two persistence classes with the highest rates of PrEP discontinuation will be selected for qualitative interviews to examine intervention preferences and barriers and facilitators of sustained PrEP use within each subgroup. Clinician stakeholders will also be interviewed to assess capacity to provide differentiated interventions. In Aim 3, evidence-based adherence strategies will be identified and adapted based on qualitative insights from Aim 2. An intervention protocol will be developed, iteratively revised with input from topical experts, and piloted to assess feasibility and acceptability. Findings will inform the development of a future efficacy trial. The proposed research and training plan will provide Dr. Hojilla with the necessary skillset to achieve his long-term career goal. He will gain training in 1) advanced quantitative analytical approaches to estimate longitudinal growth trajectories; 2) qualitative research methods to understand stakeholder needs; and 3) intervention adaptation to develop tailored strategies. He will be supported by a multidisciplinary team of mentors at the University of California, San Francisco (UCSF) and the KPNC Division of Research. Dr. Hojilla's training will prepare him to lead high-impact research evaluating precision behavioral interventions to optimize HIV prevention strategies, such as PrEP, in populations with SU.

摘要/项目摘要 Hojilla 博士的长期职业目标是成为一名独立资助的研究人员，拥有以下方面的专业知识： HIV 预防和精准行为干预，以优化生物医学预防策略，例如预防 在物质使用 (SU) 人群中进行暴露预防 (PrEP)。 PrEP 是终结疾病的关键支柱 流行病倡议，虽然使用率正在增加，但 PrEP 的高终止率威胁着公众 健康影响。 SU，包括吸毒和不健康饮酒，是公认的 HIV 风险预测因素， 存在依从性差和护理保留率低的重叠脆弱性。早期停止 PrEP 是随后感染艾滋病毒的一个关键预测因素，但很少有持久性干预措施，特别是对于 具有 SU 的个体。根据个人需求采取差异化干预措施， HIV 治疗文献中显示了有希望的发现，但尚未在 PrEP 背景下进行评估。 使用 ADAPT-ITT 框架，该 K23 应用程序的总体目标是适应现有证据- 基于坚持策略，为 SU 人群制定差异化的 PrEP 持久性干预措施。 该研究将利用北加州 Kaiser Permanente 的大型临床 PrEP 患者队列 (KPNC)，一个综合医疗保健服务系统。目标 1 将估计个人成长轨迹，以确定 PrEP 持久性的潜在模式（类别）。我们将评估每个类别的预测变量并进行比较 有和没有 SU 的患者之间 PrEP 使用模式的差异。通过以下方式理解模式 随着时间的推移，哪些患者使用 PrEP 以及预测 PrEP 使用问题模式的特征将 让我们能够区分需要干预的个人，并评估哪些干预措施对患者最有效 给定子群。在目标 2 中，来自两个持续类别的 SU 患者 PrEP 率最高 将选择停药者进行定性访谈，以检查干预偏好和障碍，并 每个亚组内持续使用 PrEP 的促进者。临床医生利益相关者也将接受采访 评估提供差异化​​干预措施的能力。在目标 3 中，基于证据的依从策略将是 根据目标 2 的定性见解进行识别和调整。将制定干预方案， 根据专题专家的意见进行迭代修订，并进行试点以评估可行性和可接受性。发现 将为未来疗效试验的发展提供信息。拟议的研究和培训计划将为博士提供。 Hojilla 拥有实现长期职业目标所需的技能。他将接受 1) 高级培训 估计纵向增长轨迹的定量分析方法； 2）定性研究方法 了解利益相关者的需求； 3）干预适应以制定量身定制的策略。他将会是 由加州大学旧金山分校 (UCSF) 和 KPNC 研究部。 Hojilla 博士的培训将为他领导高影响力的研究评估做好准备 精确的行为干预措施，以优化 SU 人群中的 HIV 预防策略，例如 PrEP。