Characterizing the HIV pre-exposure prophylaxis care continuum for African American and Hispanic/Latino men who have sex with men

项目概要 年轻的非裔美国人 (AA) 和西班牙裔/拉丁裔 (H/L) MSM 感染艾滋病毒的比例过高 美国（US）的疾病负担。暴露前预防（PrEP）对于减少艾滋病毒非常有效 MSM 中存在感染风险，但减少 AA 和 H/L MSM 中 HIV 感染的能力取决于 在“现实世界”临床环境中的最佳实施和扩大使用。初步研究表明 AA 和 H/L 启动 PrEP 并保留在 PrEP 护理中的比率低于白人同行，但几乎没有 了解 AA 和 H/L MSM 中长期坚持和保留 PrEP 护理的情况。中的方式 哪些结构、社会和个人层面的因素会影响现实环境中的 PrEP 结果，特别是 在年轻的 AA 和 H/L MSM 中，尚未得到很好的了解。启动 PrEP 的 MSM 可能会改变行为 （例如，与 HIV 阴性伴侣建立一夫一妻制关系）并且不再适用 PrEP。 此外，目前还不清楚为什么个体，尤其是 AA 和 H/L MSM，没有保留在 PrEP 护理中 这使得制定适当的干预措施以提高 PrEP 护理的保留变得复杂。这个提议 研究遵循现实世界 PrEP 中 White、AA 和 H/L MSM 的纵向观察队列 (n=450) 密西西比州、密苏里州和罗德岛州的项目旨在描述 PrEP 护理连续性并预测 为什么 MSM 的依从性不佳或失去护理，重点是衡量种族和民族差异 （具体目标1）。我们将对接受 PrEP 但效果不佳的 MSM 进行单独访谈 坚持或退出 PrEP 护理（具体目标 2），以阐明坚持不理想的原因，以及 保留并确定潜在干预措施的组成部分，以提高护理的依从性和保留率。 使用来自我们纵向队列的数据，我们将在基于代理的背景下进行微观模拟 模型评估次优 PrEP 依从性和护理保留对三名患者的 HIV 发病率的影响 多样化的美国环境。然后我们将预测潜在干预措施对 PrEP 护理连续性的影响 结果（具体目标 3）。

PROJECT SUMMARY Young African American (AA) and Hispanic/Latino (H/L) MSM bear a disproportionate share of the HIV disease burden in the United States (US). Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV acquisition risks among MSM, but its ability to reduce HIV acquisition among AA and H/L MSM hinges on optimal implementation and expanded use in “real-world” clinical settings. Preliminary studies demonstrate that AA and H/L initiate PrEP and are retained in PrEP care at lower rates than their White counterparts, but little is known about longer-term adherence and retention in PrEP care among AA and H/L MSM. The manner in which structural, social, and individual level factors impact PrEP outcomes in real-world settings, particularly among young AA and H/L MSM, are not yet well understood. MSM who initiate PrEP may change behaviors (e.g., enter a monogamous relationship with an HIV negative partner) and no longer be indicated for PrEP. Furthermore, it is largely unknown why individuals, especially AA and H/L MSM, are not retained in PrEP care which complicates development of appropriate interventions to enhance retention in PrEP care. This proposed study follows a longitudinal, observational cohort (n=450) of White, AA and H/L MSM in real-world PrEP programs in Mississippi, Missouri, and Rhode Island to both characterize a PrEP care continuum and predict why MSM are sub-optimally adherent or lost to care, with a focus on measuring racial and ethnic disparities (Specific Aim 1). We will conduct individual interviews with MSM who are prescribed PrEP but sub-optimally adherent or drop out of PrEP care (Specific Aim 2) to elucidate reasons for sub-optimal adherence and retention and to identify components of potential interventions to improve adherence and retention in care. Using data from our longitudinal cohort, we will perform microsimulations in the context of an agent-based model to evaluate the impact of sub-optimal PrEP adherence and retention in care on HIV incidence in three diverse US settings. We will then predict the impact of potential interventions on PrEP care continuum outcomes (Specific Aim 3).