RP1 Screen 2 Prevent

RP1 屏蔽 2 预防

• 批准号: 10595901
• 负责人: Lisa B Hightow-Weidman
• 金额: $ 91.51万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-25 至 2029-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595901
• 关键词: AIDS prevention; Accident and Emergency department; Accounting; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent; Adolescent Medicine Trials Network; Adolescent and Young Adult; Adult; Affect; Applied Research; Awareness; Behavior; Caring; Centers for Disease Control and Prevention (U.S.); Chlamydia; Clinic; Clinical; Clinical effectiveness; Collection; Consensus; Data; Data Reporting; Diagnosis; Electronic Health Record; Electronics; Emergency Care; Emergency department visit; Epidemic; Geographic Locations; Geography; Goals; Gonorrhea; HIV; HIV Infections; HIV/AIDS; Health Status; Health Technology; Health education; Healthcare; Hour; Human immunodeficiency virus test; Infection; Infection prevention; Infrastructure; Intervention; Leadership; Link; Literature; Location; Logistics; Methods; Modeling; Outcome; Patient Outcomes Assessments; Patients; Persons; Population; Prevention; Prevention strategy; Preventive healthcare; Primary Care; Provider; Recommendation; Research; Risk; Risk Assessment; Risk Factors; Sexual Health; Site; System; Test Result; Text Messaging; Translating; United States; Viral; Work; Youth; age group; antiretroviral therapy; behavior change; candidate identification; clinical decision support; clinical practice; comparative effectiveness trial; computed tomography screening; computerized; cost; cost effective; cost effectiveness; design; digital health; digital healthcare; evidence base; health care settings; high risk; high risk sexual behavior; improved; innovation; insight; mHealth; novel; pediatric emergency; pragmatic trial; pre-exposure prophylaxis; prevent; primary care services; response; screening; screening program; stem; success; telehealth; treatment adherence; uptake

PROJECT SUMMARY Adolescents and young adults (AYA) are disproportionately affected by HIV in the US. Despite adolescents accounting for over 20% of new infections, this age group is the least likely to be tested for HIV, linked to care, and achieve viral suppression as compared to their adult counterparts. Further, AYA also have low rates of HIV Pre-Exposure Prophylaxis (PrEP) awareness and uptake. Therefore, there is an urgent need to expand HIV screening and prevention strategies to nontraditional healthcare settings such as emergency departments (ED) to reach AYA who would otherwise not receive preventive healthcare. The goal of this application is to leverage our recent insights obtained from a multi-center, ED-based, adolescent gonorrhea and chlamydia screening study to determine the most clinically and cost-effective HIV screening approach for AYA that will also use digital health and rapid start PrEP or antiretroviral therapy (ART) for at risk youth. This will be accomplished through the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) by leveraging its infrastructure which includes geographically diverse site consortiums including adolescent clinics and their associated pediatric EDs. This research will contribute to the evidence base for creating clinically effective, cost-effective, and sustainable HIV screening programs that can be successfully implemented into the clinical workflow of the ED. It will also improve identification and linkage to PrEP/ART care for at risk adolescents using mHealth strategies by first identifying AYA who are PrEP/ART candidates based on their responses to a computerized sexual health screen (cSHS) and subsequently providing clinical decision support (CDS) to providers via the electronic health record and educational information by text message directly to PrEP/ART candidates based on their HIV results. This intervention will rely on an innovative approach that electronically integrates patient-reported data to guide CDS. This work is significant because it has the potential to fill gaps in the literature needed to provide evidence for the best method of HIV screening in a pediatric ED setting. First, we will conduct a pragmatic comparative effectiveness trial of targeted HIV screening (screening only those disclosing high risk sexual behavior) versus universally offered HIV screening (both opt-in and opt-out methods offered to all, regardless of risk) through electronic integration of patient reported data for provision of CDS and identification of PrEP candidacy. Based on HIV test results, we will then harness digital health for status neutral rapid or same-day mHealth PrEP/ART start (SMART) and linkage to care. This research is novel in that it shifts the usual clinical practice paradigm of HIV screening and prevention in the pediatric ED from a scattered approach to a consistent and sustainable approach that is critical to addressing the HIV epidemic among AYA.

项目摘要 在美国，青少年和年轻人（AYA）受到艾滋病毒的影响不成比例。尽管青少年 占新感染人数的20%以上，这一年龄组最不可能接受艾滋病毒检测，与护理有关， 并且与它们的成人对应物相比实现病毒抑制。此外，AYA的艾滋病毒感染率也很低 暴露前预防（PrEP）意识和吸收。因此，迫切需要扩大艾滋病毒 非传统医疗机构（如急诊科（艾德））的筛查和预防策略 帮助那些原本无法获得预防性保健的AYA。此应用程序的目标是 利用我们最近从多中心，ED，青少年淋病和衣原体获得的见解， 筛选研究，以确定最具临床和成本效益的艾滋病毒筛查方法， 还使用数字健康和快速启动PrEP或抗逆转录病毒治疗（ART）的风险青年。这将是 通过艾滋病毒/艾滋病干预青少年医学试验网络（ATN）， 其基础设施包括地理位置不同的网站联盟，包括青少年诊所及其 相关儿科急诊室。这项研究将有助于建立临床有效的证据基础， 具有成本效益和可持续的艾滋病毒筛查计划，可以成功地实施到临床 它还将改善对高危青少年的PrEP/ART护理的识别和联系 使用移动健康策略，首先根据他们对一个 计算机化的性健康筛查（cSHS），随后提供临床决策支持（CDS）， 提供者通过电子健康记录和教育信息通过短信直接向PrEP/ART 候选人根据他们的艾滋病毒结果。这种干预将依赖于一种创新的方法， 整合患者报告的数据以指导CDS。这项工作意义重大，因为它有可能填补 文献需要为儿科艾德环境中HIV筛查的最佳方法提供证据。第一、 我们将进行一项针对性的艾滋病毒筛查（只筛查那些 披露高风险性行为）与普遍提供的艾滋病毒筛查（包括选择加入和选择退出方法 提供给所有人，无论风险如何），通过电子整合患者报告的数据提供CDS， 识别PrEP候选人。根据艾滋病毒检测结果，我们将利用数字健康实现状态中立 快速或当天mHealth PrEP/ART启动（SMART）和护理联系。这项研究的新颖之处在于， 儿科艾德的HIV筛查和预防的通常临床实践范例来自分散的 这是一种一致和可持续的方法，对解决艾滋病毒在AYA中的流行至关重要。