Implementation of Rapid HIV Testing and Linkage to HIV Treatment or Prevention Among Vulnerable Populations in Tennessee

项目摘要 人类免疫缺陷病毒（HIV）感染仍然是美国的一个重大公共卫生问题 （美国）。据估计，在美国117万艾滋病毒感染者（PLWH）中，近15%的人不知道 他们的艾滋病状况。尽管存在高效的艾滋病毒治疗（抗逆转录病毒疗法，ART）， 只有65%的艾滋病毒感染者得到了病毒抑制。同样，在艾滋病毒阴性者中， 有资格获得PrEP的人中，只有18%使用过PrEP。证据和实践之间的差距加深了 在美国南部，阿片类药物危机进一步增加了该地区感染艾滋病毒的风险。为了 为了实现美国终止艾滋病毒流行（EHE）的目标，实施研究，特别是在美国南部， 需要缩小循证干预措施与艾滋病毒中性连续体实践之间的差距， 在乎因此，我们的总体目标是支持和评估可持续艾滋病毒卫生政策的实施情况， 田纳西州的艾滋病毒快速检测服务模式以及与艾滋病毒治疗（ART）或预防（PrEP）的联系 (TN)位于美国南部的一个州。我们的核心项目将侧重于实施和评估快速 谢尔比县卫生局的艾滋病毒检测和与抗逆转录病毒疗法的联系， 位于田纳西州孟菲斯（美国南部城市，在美国所有大都市艾滋病毒统计区中排名第四）的一家机构 发病率）到附近的几个瑞安怀特资助的艾滋病毒护理诊所。我们的合作项目将集中在 实施和评估艾滋病毒快速检测，并与当地PrEP提供者建立联系，包括：1）街道工程，a 社区组织（CBO）向纳什维尔社区提供注射器服务计划（SSP） 和2）一个Betor方式，一个CBO提供SSP的孟菲斯社区。我们有独特的优势， 执行我们提出的工作有三个重要原因。首先，我们计划利用现有的 与孟菲斯和纳什维尔的实施和社区合作伙伴合作，包括来自 圣裘德儿童研究医院，孟菲斯大学，谢尔比县卫生部，街 工作，和一个赌徒的方式。其次，我们将利用田纳西州艾滋病研究中心的资源， 范德比尔特卫生服务研究中心和Meharry-范德比尔特联盟/社区 研究核心。第三，参与这项建议的调查人员具有艾滋病毒方面的专门知识 临床护理和预防，实施科学和公共卫生实践，以完成 提议的工作。拟议的研究将支持实施一项适合具体情况的快速 在田纳西州的孟菲斯和纳什维尔，艾滋病毒检测和与艾滋病毒治疗（ART）或预防（PrEP）的联系。的 研究结果将为未来将这些模型扩展到田纳西州的其他艾滋病毒检测、护理和预防地点提供信息， 美国艾滋病毒感染率差距的中心地带。重要的是，我们的工作将支持 孟菲斯和纳什维尔社区通过利用我们独特的 学术、公共卫生和社区伙伴关系。

Project Summary Human Immunodeficiency Virus (HIV) infection remains a significant public health problem in the United States (US). It is estimated that almost 15% of the 1.17 million people living with HIV (PLWH) in the US are unaware of their HIV status. And despite the existence of highly effective HIV treatment (antiretroviral therapy, ART), only 65% of people living with diagnosed HIV have achieved viral suppression. Similarly, among HIV-negative people eligible for PrEP, only 18% have used PrEP. These gaps between evidence and practice are deepened in the US South, where the opioid crisis has further increased the risk for acquiring HIV in this region. In order to achieve US Ending the HIV Epidemic (EHE) goals, implementation research, particularly in the US South, is needed to close the gap between evidence-based interventions and practice in the HIV neutral continuum of care. Thus, our overarching goal is to support and evaluate the implementation of a sustainable HIV health service model for rapid HIV testing and linkage to HIV treatment (ART) or prevention (PrEP) in Tennessee (TN), a state located in the US South. Our Core Project will focus on implementation and evaluation of rapid HIV testing and linkage to ART from the Shelby County Health Department, the highest volume HIV testing facility in Memphis, TN (a southern US city which ranks 4th among all US Metropolitan Statistical Areas for HIV incidence) to several nearby Ryan White-funded HIV care clinics. Our Collaborative Project will focus on implementation and evaluation of rapid HIV testing and linkage to local PrEP providers from: 1) Street Works, a Community Based Organization (CBO) providing a Syringe Service Program (SSP) to the Nashville community and 2) A Betor Way, a CBO providing a SSP to the Memphis community. We are uniquely positioned to perform the work we propose for three important reasons. First, we plan to leverage an established collaboration with implementation and community partners in Memphis and Nashville including colleagues from St. Jude Children’s Research Hospital, University of Memphis, Shelby County Health Department, Street Works, and A Betor Way. Second, we will leverage resources available at the TN Center for AIDS Research, Vanderbilt Center for Health Services Research, and the Meharry-Vanderbilt Alliance/Community Engaged Research Core. Thirdly, the investigators involved in this proposal possess the expertise in HIV clinical care and prevention, implementation science, and public health practice necessary to complete the proposed work. The proposed study will support the implementation of a contextually appropriate rapid HIV testing and linkage to HIV treatment (ART) or prevention (PrEP) in Memphis and Nashville, TN. The results will inform future scaling of these models to additional HIV testing, care, prevention sites across TN, a geographic area at the epicenter of important US HIV disparities. Importantly, our work will support the Memphis and Nashville communities in reaching their local EHE goals through leveraging of our unique academic, public health, and community-based partnerships.