Come As You Are - Assessing the Efficacy of a Nurse Case Management HIV Prevention and Care Intervention among Homeless Youth

经历无家可归的年轻人感染艾滋病毒的风险很高，流行率估计高达13%， 强调了有针对性的艾滋病毒预防计划的必要性。YH参与的性危险行为比 有稳定住房的青年，但没有充分利用现有的艾滋病毒预防方案和预防护理服务，包括 低摄取PrEP和nPEP。通过激励性访谈(MI)增强护士病例管理(NCM) 策略和行为反馈可以增加年轻人采用和遵守行为和行为的参与度 生物医学艾滋病毒预防方法。NCM是一种经过验证的公共卫生方法，涉及协调、 由注册护士提供个性化的全面护理，包括健康评估、护理计划 发展、预防教育、卫生和社会服务导航并解决社会问题 健康决定因素，包括行为、心理社会和情景因素，以优化艾滋病毒预防 这些高危人群。在全面寻求健康和应对框架的指导下，我们将 对YEH 16-25提供的增强型NCM干预NCM4HIV进行随机对照试验 与健康和社会服务提供者合作评估干预对摄取的影响 支持和遵守艾滋病毒预防战略。NCM4HIV是一种增强的HIV预防病例管理 提供直接的艾滋病毒预防服务(PrEP、nPEP)和使用MI的个性化艾滋病毒预防规划 和行为反馈技术。目标1：确定增强的NCM干预是否增加 采用艾滋病毒预防战略(PrEP和nPEP吸收、艾滋病毒检测、性传播感染筛查和治疗，以及 使用避孕套)与叶氏通常接受的护理(N=450；年龄16-25岁)相比。目标2：确定 与对照组相比，NCM4HIV是否改善了精神健康、物质使用和住房状况 青年在基线、即刻、3、6和9个月。作为探索性目标，我们将确定 无论是寻求健康、应对、艾滋病毒风险认知、PrEP/nPEP障碍和促进剂，还是避孕套自我 效能中介干预对PrEP/nPEP摄取和避孕套使用的影响。这一早期阶段和 新研究人员发起的R01具有重要意义，因为它有能力提高艾滋病毒预防的接受度 战略和减少高发人群中新的艾滋病毒病例。NCM4HIV具有创新性，因为它使用 护士直接提供增强的NCM，并可应用于改善任何现有的YH HIV预防 计划，使其成为一种高度可扩展和可持续的模式，利用了“原样来”的方法 由全国无家可归者医疗保健委员会(NHCHC)推动。它与美国国立卫生研究院的HIV High保持一致 通过确定可持续地采用、整合和扩大战略来减少艾滋病毒的优先研究领域 对艾滋病毒高发人群和药物使用人群的干预。如果NCM4HIV是有效的，我们将与 NHCHC将把它扩展到300个项目和3300个无家可归者诊所，为经历过 无家可归。

Youth experiencing homelessness (YEH) are at high risk for HIV, with prevalence estimates as high as 13%, underscoring the need for targeted HIV prevention programs. YEH engage in more sexual risk behaviors than stably housed youth, yet underutilize existing HIV prevention programs and prevention care delivery, including low uptake of PrEP and nPEP. Nurse case management (NCM) enhanced with motivational interviewing (MI) strategies and behavioral feedback may increase engagement of youth to adopt and adhere to behavioral and biomedical HIV prevention methods. NCM is a proven public health approach that involves coordinated, individualized, comprehensive care delivered by a registered nurse that includes health assessment, care plan development, prevention education, and health and social service navigation and addresses the social determinants of health including behavioral, psychosocial, and situational factors to optimize HIV prevention in this high risk population. Guided by the Comprehensive Health Seeking and Coping Framework, we will conduct a randomized controlled trial of an enhanced NCM intervention, NCM4HIV, delivered to YEH 16-25 years old in collaboration with health and social service providers to assess the intervention’s effect on uptake of and adherence to HIV prevention strategies. NCM4HIV is an enhanced HIV prevention case management that provides direct HIV prevention services (PrEP, nPEP) and individualized HIV prevention planning using MI and behavior feedback technology. Aim 1: Determine whether the enhanced NCM intervention increases uptake of HIV prevention strategies (PrEP and nPEP uptake, HIV testing, STI screening and treatment, and condom use) when compared with usual care received by YEH (N=450; aged 16-25 years). Aim 2: Determine whether NCM4HIV improves mental health, substance use, and housing status when compared with control youth at baseline, immediate post and 3, 6, and 9 months. As an exploratory aim, we will determine whether whether health seeking, coping, HIV risk perception, PrEP/nPEP barriers and facilitators, and condom self- efficacy mediate the effect of the intervention on uptake of PrEP/nPEP and condom use. This early-stage and new-investigator initiated R01 is significant because it has the ability to improve uptake of HIV prevention strategies and reduce new HIV cases in a high-prevalence group. NCM4HIV is innovative because it uses nurses to directly deliver enhanced NCM and can be applied to improve any existing YEH HIV prevention program, making it a highly scalable and sustainable model that capitalizes on the “come as you are” approach promoted by the National Healthcare for the Homeless Council (NHCHC). It aligns with the NIH HIV High Priority Research Areas for reducing HIV by identifying strategies to adopt, integrate, and scale up sustainable interventions in high HIV-prevalence and substance-using groups. If NCM4HIV is efficacious, we will work with NHCHC to scale it across the 300 programs and 3,300 homeless clinics that serve youth experiencing homelessness.