Come As You Are - Assessing the Efficacy of a Nurse Case Management HIV Prevention and Care Intervention among Homeless Youth

无家可归的青年感染艾滋病毒的风险很高，估计患病率高达13%， 强调有针对性的艾滋病毒预防计划的必要性。YEH参与更多的性风险行为， 稳定居住的青年，但未充分利用现有的艾滋病毒预防方案和预防保健服务，包括 PrEP和nPEP的低摄取。护士个案管理（NCM）加强与动机访谈（MI） 战略和行为反馈可以增加青年的参与， 生物医学艾滋病毒预防方法。NCM是一种经过验证的公共卫生方法， 由注册护士提供的个性化综合护理，包括健康评估、护理计划 发展、预防教育、卫生和社会服务导航，并解决社会 健康的决定因素，包括行为，心理社会和情境因素，以优化艾滋病毒预防， 这个高危人群。在综合健康寻求和应对框架的指导下，我们将 进行一项随机对照试验，加强NCM干预，NCM 4 HIV，交付给YEH 16-25 与卫生和社会服务提供者合作，评估干预措施对吸收的影响 艾滋病毒预防战略的执行和遵守。NCM 4 HIV是一种增强的艾滋病毒预防病例管理 提供直接的艾滋病毒预防服务（PrEP，nPEP）和使用MI的个性化艾滋病毒预防计划 和行为反馈技术。目标1：确定加强的国家协调机制干预是否增加 采用艾滋病毒预防战略（PrEP和nPEP的采用、艾滋病毒检测、性传播感染筛查和治疗， 避孕套使用）与YEH（N=450;年龄16-25岁）接受的常规护理相比。目标2：确定 与对照组相比，NCM 4 HIV是否改善了心理健康、物质使用和住房状况 基线、术后即刻和3、6和9个月时的青年。作为一个探索性的目标，我们将确定 是否寻求健康，应对，艾滋病毒风险认知，PrEP/nPEP障碍和促进因素，以及安全套自我- 有效性介导干预对PrEP/nPEP吸收和避孕套使用的影响。这个早期阶段， 新研究者启动的R 01具有重要意义，因为它能够改善艾滋病毒预防的吸收 艾滋病毒/艾滋病高流行率群体中的艾滋病毒/艾滋病新病例。NCM 4 HIV是创新的，因为它使用 护士直接提供增强的NCM，并可用于改善任何现有的YEH艾滋病毒预防 计划，使其成为一个高度可扩展和可持续的模式，利用“来，因为你是”的方法 由国家无家可归者保健理事会（NHCHC）推动。它与NIH HIV High 通过确定采用、整合和扩大可持续发展战略来减少艾滋病毒的优先研究领域 艾滋病毒高流行率和药物使用群体的干预措施。如果NCM 4 HIV有效，我们将与 NHCHC将其扩展到300个项目和3，300个无家可归者诊所， 无家可归

Youth experiencing homelessness (YEH) are at high risk for HIV, with prevalence estimates as high as 13%, underscoring the need for targeted HIV prevention programs. YEH engage in more sexual risk behaviors than stably housed youth, yet underutilize existing HIV prevention programs and prevention care delivery, including low uptake of PrEP and nPEP. Nurse case management (NCM) enhanced with motivational interviewing (MI) strategies and behavioral feedback may increase engagement of youth to adopt and adhere to behavioral and biomedical HIV prevention methods. NCM is a proven public health approach that involves coordinated, individualized, comprehensive care delivered by a registered nurse that includes health assessment, care plan development, prevention education, and health and social service navigation and addresses the social determinants of health including behavioral, psychosocial, and situational factors to optimize HIV prevention in this high risk population. Guided by the Comprehensive Health Seeking and Coping Framework, we will conduct a randomized controlled trial of an enhanced NCM intervention, NCM4HIV, delivered to YEH 16-25 years old in collaboration with health and social service providers to assess the intervention’s effect on uptake of and adherence to HIV prevention strategies. NCM4HIV is an enhanced HIV prevention case management that provides direct HIV prevention services (PrEP, nPEP) and individualized HIV prevention planning using MI and behavior feedback technology. Aim 1: Determine whether the enhanced NCM intervention increases uptake of HIV prevention strategies (PrEP and nPEP uptake, HIV testing, STI screening and treatment, and condom use) when compared with usual care received by YEH (N=450; aged 16-25 years). Aim 2: Determine whether NCM4HIV improves mental health, substance use, and housing status when compared with control youth at baseline, immediate post and 3, 6, and 9 months. As an exploratory aim, we will determine whether whether health seeking, coping, HIV risk perception, PrEP/nPEP barriers and facilitators, and condom self- efficacy mediate the effect of the intervention on uptake of PrEP/nPEP and condom use. This early-stage and new-investigator initiated R01 is significant because it has the ability to improve uptake of HIV prevention strategies and reduce new HIV cases in a high-prevalence group. NCM4HIV is innovative because it uses nurses to directly deliver enhanced NCM and can be applied to improve any existing YEH HIV prevention program, making it a highly scalable and sustainable model that capitalizes on the “come as you are” approach promoted by the National Healthcare for the Homeless Council (NHCHC). It aligns with the NIH HIV High Priority Research Areas for reducing HIV by identifying strategies to adopt, integrate, and scale up sustainable interventions in high HIV-prevalence and substance-using groups. If NCM4HIV is efficacious, we will work with NHCHC to scale it across the 300 programs and 3,300 homeless clinics that serve youth experiencing homelessness.