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

项目总结 年轻的非裔美国人(AA)和西班牙裔/拉丁裔(H/L)男男性接触者感染艾滋病毒的比例不成比例 美国的疾病负担。暴露前预防(PrEP)在减少艾滋病毒方面非常有效 男男性接触者获得风险，但其能否减少AA和H/L男男性接触艾滋病病毒的能力取决于 在“真实世界”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启动了PrEP，他们在PrEP护理中的保留率低于他们的White同行，但几乎没有 已知AA和H/L男男性接触者在PrEP护理中的长期坚持和保留。中的举止 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，尤其是 在年轻的AA和H/L MSM中，还没有很好的了解。发起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)，不再提示PrEP。 此外，为什么个人，特别是AA和H/L MSM没有保留在PrEP护理中，在很大程度上是未知的 这使开发适当的干预措施以提高PrEP护理的保留率变得复杂。这项建议 这项研究跟踪了真实世界PrEP中的怀特、AA和H/L MSM的纵向观察队列 密西西比州、密苏里州和罗德岛州的计划都描述了PrEP护理连续体的特征并预测 为什么MSM的依从性或失去关爱的程度不是最好的，重点是衡量种族和民族差异 (具体目标1)。我们将对服用PrEP但效果不佳的男男性接触者进行个别访谈 坚持或退出PrEP护理(具体目标2)，以阐明遵从性不佳的原因和 并确定潜在干预措施的组成部分，以提高护理中的依从性和保留率。 使用我们纵向队列的数据，我们将在基于代理的环境中执行微观模拟 评估次优PrEP依从性和保留率对三年HIV发病率影响的模型 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 成果(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).