Developing and assessing the feasibility of a home-based PrEP support program

描述(申请人提供)：在2006-2009年间，在美国，男男性行为者(MSM)中的性传播是艾滋病毒感染的主要原因。暴露前化学预防(PrEP)已被证明可将艾滋病毒感染事件减少44%，提供了大量的公共卫生机会。服用PrEP的男性被要求至少进行季度监测，包括艾滋病毒和性传播感染的实验室检测，服药依从性和风险行为评估，以及必要时与咨询的联系。目前，男性必须去他们的服务提供者那里获得这种服务，这一制度给提供者和患者都带来了巨大的负担。如果PrEP要扩大到覆盖美国符合条件的高危MSM，我们估计每年将需要数百万患者就诊。这项拟议的研究旨在通过开发基于家庭的监测和支持系统，使PrEP扩大规模更具可行性。基于家庭的系统可以减少患者和提供者的负担，增加患者接受或保留或保留PrEP的意愿，促进由非专家提供PrEP护理，并作为一个节省成本的计划。我们建议进行定性的、形成性的工作，以开发基于家庭的PrEP监测系统，该系统将包括(1)使用邮寄试剂盒自我收集样本；(2)在线智能手机或短信对服药依从性和性行为风险的评估；以及(3)视频/电话咨询支持。在开发了PrEP监测和支持系统后，我们的目标是在旧金山、波士顿和亚特兰大对目前正在接受PrEP方案的一组MSM进行试点。

DESCRIPTION (provided by applicant): Sexual transmission among men who have sex with men (MSM) accounted for the majority of incident HIV infections in the United States from 2006-2009. Preexposure chemoprophylaxis (PrEP) has been shown to reduce incident HIV infection by 44%, providing a substantial public health opportunity. Men on PrEP are required to have a least quarterly monitoring that includes laboratory testing for HIV and sexually transmitted infections, medication adherence and risk behavior assessments, and linkage with counseling, if needed. Currently, men must visit their providers for such services, a system that places a large burden on both providers and patients. If PrEP were to be scaled up to cover eligible, high-risk MSM in the United States, we estimate that millions of yearly patient visits would be required. The proposed research seeks to make PrEP scale-up more feasible, by developing a home-based monitoring and support system. A home-based system could have the benefits of decreasing patient and provider burdens, increasing patient willingness to undergo or remain or PrEP, facilitating the provision of PrEP care by non-specialists, and being a cost-saving program We propose to conduct qualitative, formative work to develop a home-based PrEP monitoring system that would consist of (1) specimen self-collection using mail-in kits; (2) online smartphone or SMS assessment of medication adherence and sexual behavior risk; and (3) video/telephone counseling support. After development of the PrEP monitoring and support system, we aim to pilot the program with a group of MSM currently on PrEP regimens in San Francisco, Boston and Atlanta.