The Southern Pre-Exposure Prophylaxis Cohort Study: Longitudinal PrEP Initiation and Adherence among Parolees

项目摘要 据估计，涉及刑事司法(CJ)的个人的艾滋病毒流行率比 普通民众。假释犯获释后监管面临多层次障碍 (例如，无法获得住房、就业)是艾滋病毒预防工作的障碍，使现有的 预防艾滋病毒的方法不足以减少艾滋病毒发病率。暴露前预防(PrEP)是一种 一次已证明对预防艾滋病毒有效的每日用药(恩曲他滨/替诺福韦、FTC/TDF) 在高危人群中。对PrEP的知识、可接受性、启动和持续使用知之甚少 在最近出狱的假释犯中，或这些模式如何因个人而异(艾滋病毒风险因素， 社会人口特征)、社会(耻辱、社会支持)和结构(住房、就业) 各种因素。因此，我们建议在北卡罗来纳州进行一项观察性的多地点队列研究， 肯塔基州和佛罗里达州--南部假释犯暴露前预防[PrEP]队列研究 (规范-P)。这项研究是在社会生态模型和NIMHD少数民族健康与健康的指导下进行的 差异研究框架，两者的重点都超出了个人和 认识到多层次(个人、社会和结构)因素在 持续的健康差距。拟议研究的具体目的是：1)表征PrEP知识 和被假释者的接受度；2)确定预测PrEP开始和持续的多层次因素 在假释犯中使用；3)定性评估影响PrEP接受性、启发性的多层次因素 并持续使用，为未来的干预发展提供信息。拟议中的项目将是第一个 观察性队列研究，包括一名CJ参与的艾滋病毒感染极端风险人群。我们的 这项研究与NIH、NIMHD科学愿景和 艾滋病研究办公室：a)推进对改善少数群体健康或减少 健康差距；和b)减少艾滋病毒/艾滋病的发病率，并执行战略，以改善进入 预防服务。

PROJECT ABSTRACT The estimated HIV prevalence among criminal justice (CJ) involved individuals is three times higher than the general population. Parolees on post-release supervision after release experience multi-level obstacles (e.g., lack of access to housing, employment) that act as barriers to HIV prevention efforts, making existing approaches to HIV prevention insufficient for reducing HIV incidence. Pre-exposure prophylaxis (PrEP) is a once daily medication (emtricitabine/tenofovir, FTC/TDF) that has demonstrated efficacy in preventing HIV among at-risk groups. Little is known about PrEP knowledge, acceptability, initiation, and sustained use among parolees recently released from prison or how these patterns vary by individual (HIV risk factor, sociodemographic characteristics), social (stigma, social support), and structural (housing, employment) factors. Therefore, we propose to conduct an observational, multi-site cohort study in North Carolina, Kentucky, and Florida—the Southern Pre-Exposure Prophylaxis [PrEP] Cohort Study among Parolees (SPECS-P). This study is guided by the Social Ecological Model and the NIMHD Minority Health and Health Disparities Research Framework, which both have a focus extending beyond the individual and acknowledge that multi-level (individual, social, and structural) factors play a role in the perpetuation of persistent health disparities. The specific aims of the proposed study are: 1) characterize PrEP knowledge and acceptability among parolees; 2) identify the multi-level factors that predict PrEP initiation and sustained use among parolees; 3) qualitatively assess the multi-level factors that affect PrEP acceptability, initiation and sustained use to inform future intervention development. The proposed project will be the first observational cohort study that includes a CJ involved population at extreme risk for HIV acquisition. Our study is aligned with the following high priority topics as defined by the NIH, NIMHD Science Visioning, and Office of AIDS Research: a) advancing evaluation of approaches to improve minority health or to reduce health disparities; and b) reducing incidence of HIV/AIDS and implementing strategies to improve entry into prevention services.