PrEP-ED: PrEP Services in the Emergency Department for Hard-to-Reach Populations

HIV暴露前预防(PrEP)在美国仍然没有得到充分利用，原因是一系列结构性的、提供者的、 和个人层面的障碍。其中包括艾滋病毒风险增加的人对PrEP的认识较低，他们的有限 与医疗保健系统的接触，以及缺乏了解并愿意发起 准备好了。急诊科(ED)是识别符合PrEP条件的个人的战略地点：他们的服务 由于交叉的社会结构脆弱性，艾滋病毒感染风险不成比例的人；他们 展示了他们在成功实施艾滋病毒常规提供的基础上启动PrEP的能力 暴露后预防措施的测试和提供。然而，目前还没有基于证据的模型可供急诊室 成功地筛查、教育和激励ED患者，并将其与PrEP联系起来。成功的战略 需要应对几个挑战，包括优先处理紧急和紧急任务的ED文化 预防干预措施和患者的PrEP犹豫不决，特别是在急诊室为非PrEP就诊的情况下- 相关问题。在这款R34中，来自以色列西奈山的经验丰富的临床研究人员组成的合作伙伴 急诊医学部，HIV临床和行为研究中心的研究人员 纽约精神病研究所和哥伦比亚大学，来自爱因斯坦-洛克菲勒-纽约州立大学CFAR的研究人员 阿尔伯特·爱因斯坦医学院，以及社区组织的ED提供者专家小组 领导者和政策制定者，我们将在随机试验(RCT)中详细阐述、迭代改进并进行试点 全面的PrEP干预方案-PrEP-ED-旨在应对这些挑战。 具体目标是：目标1a。通过以下途径确定患者在急诊室接受PrEP服务的偏好 ED患者的离散选择实验(DCE)。目标1b。与专家小组一起，修订和 详细阐述ED-PrEP级联中每个步骤的策略--筛选、教育、接受和联系 持续护理，使用DCE的调查结果并借鉴专家小组的经验。目标2.落实 在ED环境下在Aim 1中开发的包，并迭代优化每个组件。目标3a。进行混合 实施有效性II型试点随机对照试验，比较优化后的PrEP-ED在AIM中的作用 2仅转诊至PrEP服务。目标3b。在干预研究综合框架的指导下， 定性地探索与未来实施相关的领域。这项提议针对的是“预防”支柱 艾滋病毒国家战略计划和艾滋病研究办公室优先减少艾滋病毒发病率。通过识别 可行和有效的PrEP评估、教育/激励、接受和联系的方法 我们的干预措施可以为人口层面的预防和减少艾滋病毒作出重大贡献 差距。

HIV pre-exposure prophylaxis (PrEP) remains underutilized in the US due to an array of structural, provider, and individual-level barriers. These include low PrEP awareness in people at increased HIV risk, their limited engagement with healthcare systems, and a paucity of providers with the knowledge and willingness to initiate PrEP. Emergency Departments (EDs) are strategic locations for identifying PrEP-eligible individuals: they serve people at disproportionate risk for HIV infection due to intersecting social-structural vulnerabilities; and they have demonstrated their capacity for initiating PrEP based on successful implementation of routine offers of HIV testing and provision of post-exposure prophylaxis. However, there are no evidence-based models for EDs to adopt that successfully screen, educate and motivate, initiate, and link ED patients to PrEP. A successful strategy needs to address several challenges, including an ED culture that prioritizes urgent and emergent tasks over preventive interventions and patients’ PrEP hesitancy, particularly in the context of an ED visit for a non-PrEP- related issue. In this R34, a partnership of experienced clinician researchers from Mount Sinai Beth Israel Department of Emergency Medicine, researchers from the HIV Center for Clinical and Behavioral Studies at NYS Psychiatric Institute and Columbia University, researchers from the Einstein-Rockefeller-CUNY CFAR at the Albert Einstein College of Medicine, and an Expert Panel of ED providers, community-based organization leaders, and policymakers, we will elaborate, iteratively refine, and pilot in a randomized trial (RCT) a comprehensive PrEP intervention package—PrEP-ED—designed to address these challenges. The specific aims are to: Aim 1a. Identify patient preferences for receiving PrEP services in the ED through a discrete-choice experiment (DCE) among ED patients. Aim 1b. Along with the Expert Panel, revise and elaborate strategies for each step in the ED-PrEP cascade—screening, education, acceptance, and linkage to ongoing care, using the DCE findings and drawing on experiences of the Expert Panel. Aim 2. Implement the package developed in Aim 1 in an ED setting and iteratively optimize each component. Aim 3a. Conduct a Hybrid Implementation-Effectiveness Type 2 pilot randomized controlled trial, comparing PrEP-ED as optimized in Aim 2 to referral to PrEP services only. Aim 3b. Guided by the Consolidated Framework for Intervention Research, explore qualitatively domains relevant to future implementation. This proposal addresses the “prevent” pillar of the HIV National Strategic Plan and the Office of AIDS Research priority to reduce HIV incidence. By identifying feasible and effective approaches to PrEP assessment, education/motivation, acceptance, and linkage in the ED our intervention could make a major contribution to population-level prevention and reduction of HIV disparities.