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

PrEP-ED：急诊科为难以接触到的人群提供的 PrEP 服务

• 批准号: 10484515
• 负责人: Ethan Adrian Cowan
• 金额: $ 26.7万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-05 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10484515
• 关键词: AIDS prevention; Accident and Emergency department; Acquired Immunodeficiency Syndrome; Address; Adopted; Awareness; Caring; Clinical; Clinical Research; Collaborations; Communities; Data; Education; Effectiveness of Interventions; Emergency Department patient; Emergency Medicine; Emergency department visit; Fumarates; HIV; HIV Infections; HIV risk; Healthcare Systems; Human immunodeficiency virus test; Incidence; Individual; Institutes; Intervention; Intervention Studies; Israel; Knowledge; Link; Location; Medicine; Modeling; Motivation; Occupational; Outcome; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Prevention; Primary Health Care; Prophylactic treatment; Provider; Randomized Controlled Trials; Recording of previous events; Research Personnel; Research Priority; Risk; Services; Site; Source; Strategic Planning; Tenofovir; Testing; Uninsured; United States; Universities; base; behavioral study; clinical center; college; design; effectiveness implementation study; emtricitabine; evidence base; experience; experimental study; follow-up; future implementation; implementation outcomes; implementation strategy; improved; innovation; interest; pre-exposure prophylaxis; prevent; preventive intervention; primary care services; primary outcome; programs; randomized trial; satisfaction; scale up; screening; social structure; trial comparing; uptake; willingness

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.

艾滋病毒暴露前预防（PrEP）在美国仍然没有得到充分利用，由于一系列的结构，提供者， 和个人层面的障碍。这些因素包括艾滋病毒风险增加的人对PrEP的认识较低， 与医疗保健系统的接触，以及缺乏知识和意愿的提供者， 制备型急诊室（ED）是识别符合PrEP条件的个人的战略位置：他们服务于 由于交叉的社会结构脆弱性，艾滋病毒感染风险过高的人; 证明他们有能力在成功实施艾滋病毒常规服务的基础上启动PrEP 检测和提供接触后预防。然而，对于ED，没有基于证据的模型， 采用成功筛选，教育和激励，启动，并联系艾德患者准备。一个成功的策略 需要解决几个挑战，包括艾德文化，优先考虑紧急和紧急任务， 预防性干预措施和患者的PrEP犹豫，特别是在非PrEP的艾德就诊的情况下， 相关问题。在这个R34中，来自西奈山贝斯以色列的经验丰富的临床研究人员合作， 急诊医学部，来自艾滋病毒临床和行为研究中心的研究人员， 纽约州精神病学研究所和哥伦比亚大学，来自爱因斯坦-洛克菲勒-纽约市立大学CFAR的研究人员在 阿尔伯特·爱因斯坦医学院和一个由艾德提供者、社区组织 领导者和政策制定者，我们将详细阐述，反复完善，并在随机试验（RCT）中进行试点。 全面的PrEP干预包-PrEP-ED-旨在应对这些挑战。 具体目标是：目标1a。通过以下方式确定患者在艾德接受PrEP服务的偏好 在艾德患者中进行离散选择实验（DCE）。目标1b。沿着专家小组，修订和 为ED-PrEP级联中的每一步制定战略-筛查，教育，接受，以及与 持续的护理，使用DCE的结果和借鉴专家小组的经验。目标2.贯彻 在艾德环境中使用目标1中开发的软件包，并迭代优化每个组件。目标3a。进行混合 实施-有效性2型初步随机对照试验，比较Aim中优化的PrEP-ED 2只转介到PrEP服务。目标3b。在干预研究综合框架的指导下， 从质量上探讨与今后执行有关的领域。这项建议涉及到“预防”支柱， 艾滋病毒国家战略计划和艾滋病研究办公室将降低艾滋病毒发病率作为优先事项。通过识别 PrEP评估、教育/激励、接受和联系的可行有效方法 艾德：我们的干预措施可以为人口水平的预防和减少艾滋病毒做出重大贡献 差距。