Theoretically Based Mobile App to Increase PrEP Uptake Among MSM

摘要 暴露前预防(PrEP)有望降低那些感染艾滋病毒的人的易感性 是HIV阴性的，定期服用PrEP。但是，PrEP的启动依赖于血清状态，并且启动PrEP 当风险出现时，要求男男性行为者(MSM)保持定期的艾滋病毒检测程序，并 定期评估PrEP资格。目前，许多男男性接触者并不定期检测艾滋病毒，PrEP的吸收率一直在上升 慢的。除非规模化，否则Prep不会对MSM中的艾滋病毒发病率产生足够的影响；PrEP 要将艾滋病毒发病率降低25%，需要40-50%的覆盖率。今天，男男性接触者中的PrEP接受率 为8.5%。我们建议测试移动应用程序(HealthMindr)在3个月中促进PrEP摄取的有效性 在MSM中有大量艾滋病毒流行的美国城市：亚特兰大，佐治亚州，杰克逊，密苏里州和华盛顿特区。这个 已经开发了预防应用程序，并在121名MSM中进行了测试；9%的符合PrEP条件的MSM使用 该应用程序在4个月的跟踪期内启动了PrEP。此外，这款应用程序被发现非常 男男性接触者可以接受。将对应用程序的PrEP组件进行较小的增强，包括添加 其他PrEP信息。该应用程序将包括自我管理的风险评估组件， 制定和支持经常进行艾滋病毒检测和每月对暴露前进行自我评估的计划 预防(PrEP)资格。该应用程序会将符合PrEP条件的人链接到具有PrEP定位器的服务 提供商，包括私人提供商和有关可用服务的详细信息，以及公共PrEP导航器。 该应用程序将在RCT和标准护理(参考现有PrEP信息和资源)中进行测试 在这三个城市。主要结果将是由替诺福韦-二磷酸证实的PrEP起始率 在干血点(DBS)样本和/或PrEP处方的照片证据中进行检测。

Abstract Pre-exposure prophylaxis (PrEP) holds great promise to reduce susceptibility to HIV infection for those who are HIV-negative and take PrEP regularly. However, PrEP initiation is serostatus dependent, and starting PrEP when risk emerges requires men who have sex with men (MSM) to maintain regular HIV testing routines and regularly assess PrEP eligibility. Currently many MSM do not test for HIV regularly, and PrEP uptake has been slow. PrEP will not have sufficient impact on HIV incidence among MSM unless it is brought to scale; PrEP coverage of 40-50% would be required to reduce HIV incidence by 25%. Today, PrEP uptake among MSM stands at 8.5%. We propose to test the efficacy of a mobile app (HealthMindr) to promote PrEP uptake in 3 US cities with substantial HIV epidemics among MSM: Atlanta, GA, Jackson, MS, and Washington, DC. The prevention app has already been developed and tested with 121 MSM; 9% of PrEP eligible MSM who used the app initiated PrEP during a 4-month follow-up period. Further, the app was found to be very acceptable to MSM. Minor enhancements to the PrEP component of the app will be made, including addition of additional PrEP information. The app will include components for self-administered risk assessments, developing and supporting a plan for frequent HIV testing, and monthly self-assessment for pre-exposure prophylaxis (PrEP) eligibility. The app will link those eligible for PrEP to services with a locator for PrEP providers, including private providers and details about services available, and with public PrEP navigators. The app will be tested in an RCT versus standard of care (referral to existing PrEP information and resources) in the three cities. The primary outcome will be rate of PrEP initiation, confirmed by tenofovir-diphosphate detection in a dried blood spot (DBS) specimen and/or photographic evidence of PrEP prescription.