Theoretically Based Mobile App to Increase PrEP Uptake Among MSM

摘要 暴露前预防（PrEP）在降低以下人群感染艾滋病毒的易感性方面具有很大的前景： HIV阴性，并定期服用PrEP。然而，PrEP启动是血清状态依赖性的， 当风险出现时，要求男男性行为者（MSM）定期进行艾滋病毒检测， 定期评估PrEP资格。目前，许多男男性行为者没有定期进行艾滋病毒检测， 慢了除非大规模推广，否则PrEP不会对MSM中的艾滋病毒发病率产生足够的影响; 要将艾滋病发病率降低25%，就需要40-50%的覆盖率。今天，MSM中的PrEP吸收 占8.5%。我们建议测试一个移动的应用程序（HealthMindr）的有效性，以促进PrEP吸收3 在男男性行为者中有大量艾滋病毒流行的美国城市：佐治亚州亚特兰大、密西西比州杰克逊和华盛顿。的 已经开发了预防应用程序，并在121名MSM中进行了测试; 9%符合PrEP条件的MSM使用了 该应用程序在4个月的随访期间启动了PrEP。此外，该应用程序被发现非常 可以接受的MSM。将对应用程序的PrEP组件进行微小的增强，包括添加 更多PrEP信息该应用程序将包括自我管理风险评估的组件， 制定和支持经常进行艾滋病毒检测的计划，并每月进行暴露前自我评估 预防（PrEP）合格性。该应用程序将把那些有资格获得PrEP的人与具有PrEP定位器的服务联系起来 提供者，包括私人提供者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与标准护理中进行测试（参考现有的PrEP信息和资源） 在这三个城市。主要结局将是PrEP启动率，由二磷酸替诺福韦证实 干血斑（DBS）标本中的检测和/或PrEP处方的照片证据。

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.