Developing a Patient Navigation Intervention for PrEP Continuum of Care among Young Latino MSM

为年轻的拉丁裔 MSM 制定患者导航干预措施，以实现 PrEP 连续护理

• 批准号: 9410944
• 负责人: Aaron J Blashill
• 金额: $ 19.78万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-10 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9410944
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Age; Awareness; California; Caring; Consultations; Continuity of Patient Care; Contracts; Data; Development; Epidemic; Feedback; Future; Goals; HIV; HIV Infections; HIV diagnosis; Health Personnel; Health Professional; Healthcare; Healthy People 2020; Hispanics; Incidence; Individual; Intervention; Intervention Studies; Interview; Knowledge; Language; Latino; Linguistics; Medical; Methods; Outcome; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Phase; Population; Preparation; Process; Public Health; Randomized; Randomized Controlled Trials; Reporting; Risk; Schedule; Services; Tenofovir; Testing; United States Food and Drug Administration; black men who have sex with men; cost; design; efficacy trial; emtricitabine; follow-up; health care availability; health literacy; high risk men; improved; medical appointment; men who have sex with men; men' s group; peer; pre-exposure prophylaxis; programs; racial and ethnic; response; social cognitive theory; social stigma; therapy design; treatment as usual; trend; uptake; willingness; young adult

PROJECT SUMMARY Men who have sex with men (MSM) are the most at-risk group for contracting human immunodeficiency virus (HIV) in the U.S., comprising 67% of new HIV diagnoses in 2014. However, the HIV epidemic impacts some groups of MSM disproportionately. Latino MSM comprise 25.1% of new HIV infections among MSM between the ages of 13 and 29 years. The daily medication tenofovir/emtricitabine was approved by the Food and Drug Administration for pre-exposure prophylaxis (PrEP) in 2012 and has demonstrated strong efficacy in reducing the risk of HIV infection. When taken consistently, PrEP has been shown to reduce new incidence of HIV by 92%. Despite the promise of PrEP to transform HIV prevention, there remain significant barriers to PrEP use among those who would benefit the most, resulting in low rates of uptake. Although Latino MSM have reported the lowest use of PrEP (6.6%), they also reported the greatest willingness to use PrEP compared to White and Black MSM. There have been no known interventions that have been designed to assist Latino MSM with accessing PrEP-related health care or adhering to PrEP. Patient navigation may be an ideal intervention to aid in PrEP uptake among Latino MSM by assisting individuals in overcoming barriers to obtaining and using PrEP. To our knowledge, no known patient navigation programs for PrEP have been developed for Latino MSM. The objectives of this proposed study are to develop, pretest, produce, and pilot test a patient navigation intervention designed to address multiple components of the PrEP cascade among Latino MSM between the age of 18 and 29. During Phase 1, qualitative data will be collected through 30 in-depth interviews to assess needs and assets of young adult Latino MSM regarding engagement and retention in the PrEP cascade. From these findings, health care provider and staff feedback, and through the guidance of a Participatory Planning Group, a patient navigation intervention will be developed and pre-tested through 25 in-depth interviews. During Phase 2, the patient navigation intervention will be pilot-tested with 60 young adult Latino MSM. The patient navigation intervention will be compared to usual care plus written information to evaluate the feasibility and acceptability of the intervention and study methods, as well as the intervention's potential in improving engagement and retention in PrEP-related care. The project will investigate the following specific aims: 1) to assess the needs and assets of young adult Latino MSM regarding engagement and retention in the PrEP cascade; 2) to develop, pretest, and produce a patient navigation intervention designed to facilitate engagement and retention in the PrEP cascade among young adult Latino MSM; and 3) to conduct a pilot randomized controlled trial of the patient navigation intervention by comparing it to usual care to assess feasibility, acceptability, and preliminary impact. The proposed study has significant public health implications and is expected to contribute to efforts to reduce HIV-related disparities and increase adherence to PrEP.

项目概要 男男性行为者 (MSM) 是感染人类免疫缺陷病毒的最高风险群体 (HIV) 在美国，占 2014 年新增 HIV 诊断的 67%。然而，HIV 流行影响了一些人 MSM 群体不成比例。拉丁裔 MSM 占 25.1% 的 MSM 新发 HIV 感染者 年龄分别为 13 岁和 29 岁。每日用药替诺福韦/恩曲他滨已获得食品药品监督管理局批准 2012 年实施暴露前预防 (PrEP)，并在减少 感染艾滋病毒的风险。如果坚持服用，PrEP 已被证明可以减少艾滋病毒的新发病率 92%。尽管 PrEP 有望改变 HIV 预防，但 PrEP 的使用仍然存在重大障碍 那些受益最多的人，导致采用率较低。尽管拉丁裔 MSM 已报道 PrEP 的使用率最低 (6.6%)，但与白人和白人相比，他们也报告了使用 PrEP 的最大意愿 黑人男同性恋者。目前尚无已知的干预措施旨在帮助拉丁裔 MSM 获得与 PrEP 相关的医疗保健或遵守 PrEP。患者导航可能是一种理想的干预措施 通过协助个人克服获取和使用的障碍，提高拉丁裔 MSM 的 PrEP 吸收率 PrEP。据我们所知，尚未为拉丁裔开发已知的 PrEP 患者导航程序 男同性恋者。这项拟议研究的目标是开发、预测试、生产和试点测试患者导航系统 旨在解决拉丁裔 MSM 之间 PrEP 级联的多个组成部分的干预措施 18岁和29岁。在第一阶段，将通过30次深度访谈收集定性数据以评估 年轻拉丁裔 MSM 在参与和保留 PrEP 级联方面的需求和资产。从 这些发现、医疗保健提供者和工作人员的反馈，以及通过参与性规划的指导 小组将通过 25 次深度访谈制定患者导航干预措施并进行预测试。 在第二阶段，患者导航干预将在 60 名年轻的拉丁裔男男性接触者中进行试点测试。这 患者导航干预将与常规护理加上书面信息进行比较，以评估可行性 干预和研究方法的可接受性，以及干预改善的潜力 参与和保留 PrEP 相关护理。该项目将研究以下具体目标：1） 评估年轻拉丁裔男男性接触者参与和保留 PrEP 的需求和资产 级联; 2) 开发、预测试和生产患者导航干预措施，旨在促进 年轻拉丁裔男男性接触者对 PrEP 级联的参与和保留； 3）进行试点 通过与常规护理进行比较来评估患者导航干预的随机对照试验 可行性、可接受性和初步影响。拟议的研究具有重大的公共卫生影响 预计将有助于减少艾滋病毒相关的差异并提高 PrEP 的依从性。