Improving the HIV PrEP Cascade using an Intervention for Healthcare Providers

家长奖项目摘要/摘要 暴露前预防(PrEP)已被证明在随机试验中对预防HIV非常有效 临床试验，但PrEP在美国的应用一直有限。实施PrEP的障碍之一是 缺乏医疗保健提供者(HCP)的知识和开处方的意愿。作为当前PrEP的结果 报道了在真实世界环境和不同人群中的配方，并报告了新的PrEP配方 六氟氯烃将继续需要支持和指导，以优化临床和公共卫生影响 这一宝贵的艾滋病毒预防战略。我们提出了一种针对HCP的PrEP优化干预 在艾滋病毒感染风险人群中增加PrEP的摄取率和持久性。这一干预包括：(1) 基于Web的集成小组管理工具PrEP-Rx，可提供结构化的艾滋病毒风险 评估，自动提醒实验室测试和预约，并报告患者的病史 准备使用；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)可以通过与患者直接接触或通过审查来确定艾滋病毒高危人群 性传播感染(STI)登记处，以及谁可以支持多个HCP。我们建议 以下目标：主要目标：评价PrEP优化干预的效果(PrEP协调员 Prep-Rx)通过阶梯楔形设计在10家初级保健诊所中增加PrEP处方。我们 假设当诊所使用 准备干预与不干预时的对比。次要目标：(1)探讨PrEP启动的差异， 使用时间，以及根据患者的年龄、种族/民族和性别/性别以及 研究诊所的临床和HCP特征；(2)探讨干预措施的可持续性 阶梯式阶段后8个月的随访；(3)调查PrEP交付的促进者和障碍 以及通过与初级保健方案、初级保健方案和初级保健方案的定性访谈，对拟议的初级保健方案干预的经验 协调人和研究诊所的诊所主任。PrEP协调器和PrEP-Rx的组合具有 有可能改进PrEP连续体的所有步骤，并通过在以下位置识别个人来增强整体护理 艾滋病毒感染的高风险，标准化艾滋病毒风险评估，帮助启动预防接种计划，系统化跟踪- 增加查访或实验室评估，并对初级卫生保健方案进行关于新出现的PrEP数据的教育。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 提供初级保健方案的创新方法，这将导致培训初级保健方案，以增加初级保健方案的数量 能够提供PrEP。最终，拟议的研究有可能缩小PrEP中的差距 卡斯卡德。

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.