Improving the HIV PrEP Cascade using an Intervention for Healthcare Providers

家长奖项目摘要/摘要 HIV暴露前预防（PrEP）已被证明是非常有效的艾滋病毒预防随机 临床试验，但在美国PrEP的吸收有限。实施PrEP的障碍之一是 缺乏医疗保健提供者（HCP）的知识和意愿，以规定它。作为目前的准备结果 制剂在现实世界中的设置和不同的人群报告和新的PrEP制剂， HCP将继续需要支持和指导，以优化临床和公共卫生影响 这一宝贵的艾滋病预防战略。我们提出了针对HCP的PrEP优化干预措施， 增加有感染艾滋病毒风险者的PrEP吸收和持续性。这种干预包括：（1） 一个名为PrEP-Rx的基于网络的综合小组管理工具，提供结构化的艾滋病毒风险 评估，自动提醒实验室检测和预约，并报告患者的病史， PrEP使用;以及（2）由临床支持人员监督的集中式PrEP协调（称为PrEP） 协调员），他们可以通过直接接触患者或通过审查 性传播感染（STI）登记处以及能够支持多个HCP的人员。我们建议 主要目的：评估PrEP优化干预的有效性（PrEP协调员+ PrEP-Rx），以通过10个初级保健诊所的阶梯楔形设计增加PrEP处方。我们 假设当诊所使用 PrEP干预与当他们不。次要目的：（1）探索PrEP启动的差异， 使用持续时间和基于患者年龄、人种/种族和性别的停药原因，以及 研究诊所之间的诊所和HCP特征;（2）探索干预期间的可持续性 （3）调查PrEP提供的促进因素和障碍 通过与HCP的定性访谈， 研究诊所的协调员和诊所主任。PrEP协调员加上PrEP-Rx的组合具有 改善PrEP连续体的所有步骤并通过识别个人来加强整体护理的潜力 艾滋病毒感染的高风险，标准化艾滋病毒风险评估，帮助PrEP启动，系统化后续工作- 增加访问或实验室评估，并教育HCP有关新出现的PrEP数据。这些目标可以有一个 对公共卫生产生重大影响，并在对现有诊所资源造成最小负担的情况下实现。我们正在使用 PrEP提供的创新方法，将导致HCP培训，以增加HCP数量 最终，拟议的研究有可能减少PrEP中的差距 级联。

Parent Award Project Summary/Abstract HIV pre-exposure prophylaxis (PrEP) has been shown to be highly effective for HIV prevention in randomized clinical trials but uptake of PrEP in the U.S. has been limited. One of the barriers to PrEP implementation is lack of healthcare provider (HCP) knowledge and willingness to prescribe it. As outcomes of current PrEP formulations in real-world settings and different populations are reported and novel PrEP formulations are introduced, HCPs will continue to require support and guidance to optimize the clinical and public health impact of this valuable HIV prevention strategy. We propose a PrEP optimization intervention targeted at HCPs to increase PrEP uptake and persistence among those at risk for HIV acquisition. This intervention includes: (1) an integrated web-based panel management tool called PrEP-Rx, which provides structured HIV risk assessment, automates reminders for laboratory testing and appointments, and reports patients' history of PrEP use; and (2) a centralized PrEP coordination overseen by a clinical support staff (referred to as the PrEP coordinator) who can identify individuals at high risk for HIV through direct patient contact or by reviewing registries for sexually transmitted infections (STIs) and who can support multiple HCPs. We propose the following aims: Primary Aim: Evaluate the efficacy of the PrEP optimization intervention (PrEP Coordinator + PrEP-Rx) to increase PrEP prescriptions through a stepped-wedge design among 10 primary care clinics. We hypothesize that the mean number of prescriptions issued will be significantly higher when the clinics use the PrEP intervention versus when they do not. Secondary Aims: (1) Explore differences in PrEP initiation, duration of use, and reasons for discontinuation based on patient's age, race/ethnicity, and sex/gender, and by clinic and HCP characteristics among study clinics; (2) Explore sustainability of the intervention during an eight-month follow-up after the stepped-wedge Phase; (3) Investigate facilitators and barriers of PrEP delivery and experiences with the proposed PrEP intervention through qualitative interviews with HCPs, PrEP Coordinators, and clinic directors of study clinics. The combination of the PrEP Coordinator plus PrEP-Rx has the potential to improve all steps of the PrEP continuum and enhance overall care by identifying individuals at high risk of HIV acquisition, standardizing HIV risk assessment, helping in PrEP initiation, systematizing follow- up visits or laboratory assessments, and educating HCPs about emerging PrEP data. These goals can have a significant public health impact and be attained with minimal burden on existing clinic resources. We are using innovative approaches for PrEP delivery which will result in training of HCPs to increase the number of HCPs capable of offering PrEP. Ultimately, the proposed research has the potential to reduce gaps in the PrEP cascade.