Packaging Pre-Exposure Prophylaxis (PrEP) to Prevent HIV Transmission among Women who Inject Drugs

包装暴露前预防 (PrEP) 以防止注射吸毒女性中艾滋病毒传播

• 批准号: 9410729
• 负责人: Alexis Marie Roth
• 金额: $ 24.74万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9410729
• 关键词: AIDS prevention; Address; Adherence; Anti-Retroviral Agents; Appointment; Baseline Surveys; Behavior Therapy; Behavioral Model; Biological Markers; Buprenorphine; Caring; Centers for Disease Control and Prevention (U.S.); Chlamydia; Clinic; Clinical; Communities; Complement; Continuity of Patient Care; Data; Drug Compounding; Drug Controls; Drug usage; Eligibility Determination; Enrollment; Face; Fumarates; Funding; Guidelines; HIV; HIV Infections; HIV risk; Health; Health Benefit; Health Insurance; High Prevalence; Incidence; Individual; Injectable; Injecting drug user; Intervention; Interview; Knowledge; Measures; Medical; Methods; Mid-Atlantic Region; Modeling; Modification; Monitor; Needle Sharing; Needle-Exchange Programs; Observational Study; Opiate Addiction; Outcome; Participant; Pharmaceutical Preparations; Population; Prevention strategy; Preventive Intervention; Primary Health Care; Public Health; Recruitment Activity; Reporting; Reproducibility; Research; Risk; Services; Sexual Partners; Sexually Transmitted Diseases; Shares syringes; Structure; Syringes; Tenofovir; Testing; Translations; Trust; Uninsured; Vulnerable Populations; Woman; Work; base; condoms; design; disorder prevention; drug testing; emtricitabine; follow-up; high risk sexual behavior; improved; innovation; men; novel strategies; pre-exposure prophylaxis; prevent; programs; prospective; sex; success; transmission process; uptake

PROJECT SUMMARY/ ABSTRACT Pre-exposure prophylaxis (PrEP) is a promising bio-medical HIV prevention strategy that involves the use of emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) by HIV negative individuals to reduce their risk of acquiring HIV. Evidence suggests women who inject drugs (WWID) are disproportionately vulnerable to HIV. While PrEP could significantly reduce HIV acquisition among WWID, at present, there is little knowledge to help address PrEP implementation challenges for this understudied group. The proposed study will address our knowledge gap about PrEP by evaluating a novel approach for the delivery of PrEP care, namely, packaging PrEP and testing and treatment for sexually transmitted infections with community-based syringe exchange program (SEPs) services. The rationale is that (1) SEPs may currently provide prescription medications and long-term monitoring for other conditions such as buprenorphine for opioid dependence, so providing PrEP care is a natural extension of what is already being done successfully; (2) SEPs are a viable access point for many HIV-uninfected WWID who would be considered eligible for PrEP under current clinical guidelines; and (3) PrEP interventions, delivered in settings already utilized and trusted by WWID, will increase uptake, adherence and retention in PrEP. Packaging PrEP care at a syringe exchange program is highly innovative. To our knowledge, this approach has not been tested and may represent a paradigm shift that enables and encourages women in this highly vulnerable population to engage in effective biomedical HIV prevention strategies. To evaluate the impact of this approach, we will initiate a prospective mixed methods study with primary and secondary syringe exchange users. Through semi-structured and in-depth interviews based on the Behavioral Model for Vulnerable Populations, and drug-level monitoring for FTC, we will address the following specific aims: (1) Describe WWID's engagement in the PrEP care continuum (focusing on critical moments when women could disengage or need additional support to remain in care). (2) Assess the impact of predisposing, enabling, and need-related factors on WWID's engagement in the PrEP care continuum. (3) Explore how and why model factors are associated with WWID's decisions and ability to engage in PrEP care. Unless new clinic-independent intervention methods are developed to target the specific barriers to PrEP found among WWID, engagement in this group is likely to remain suboptimal. The reproducibility of this approach significantly increases this work's potential for translation to other settings. The long term-impact will be a reduction in HIV and improved health outcomes of WWID through the delivery of combination HIV prevention interventions that include PrEP.

项目概要/摘要 暴露前预防 (PrEP) 是一种很有前途的生物医学 HIV 预防策略，涉及使用 HIV 阴性个体使用恩曲他滨/富马酸替诺福韦二吡呋酯 (FTC/TDF) 来降低感染风险 感染艾滋病毒。有证据表明，注射毒品的女性 (WWID) 特别容易感染艾滋病毒。 虽然 PrEP 可以显着减少 WWID 中的 HIV 感染，但目前对此知之甚少。 帮助解决这一受研究群体面临的 PrEP 实施挑战。拟议的研究将解决 通过评估一种提供 PrEP 护理的新方法，即， 使用社区注射器包装 PrEP 以及性传播感染检测和治疗 交换计划 (SEP) 服务。理由是 (1) 标准必要专利目前可以提供处方 药物治疗和长期监测其他病症，例如丁丙诺啡治疗阿片类药物依赖，因此 提供 PrEP 护理是已经成功开展的工作的自然延伸； (2) 标准必要专利是可行的 许多未感染 HIV 的 WWID 的接入点，根据当前的临床情况，他们被认为有资格接受 PrEP 指导方针； (3) 在 WWID 已经使用和信任的环境中提供的 PrEP 干预措施将会增加 PrEP 的吸收、坚持和保留。在注射器交换计划中包装 PrEP 护理非常重要 创新的。据我们所知，这种方法尚未经过测试，可能代表一种范式转变 帮助并鼓励这一高度弱势群体中的女性参与有效的艾滋病毒生物医学研究 预防策略。为了评估这种方法的影响，我们将启动一种前瞻性混合方法 与主要和次要注射器交换使用者进行研究。通过半结构化和深度访谈 基于弱势群体的行为模型和 FTC 的药物水平监测，我们将解决 以下具体目标： (1) 描述 WWID 对 PrEP 护理连续体的参与（重点关注关键问题） 妇女可以脱离或需要额外支持才能继续接受护理的时刻）。 (2) 评估影响 WWID 参与 PrEP 护理连续体的诱发因素、促成因素和需求相关因素。 (3) 探索模型因素如何以及为何与 WWID 的决策和参与 PrEP 护理的能力相关。 除非开发出新的独立于临床的干预方法来针对发现的 PrEP 的特定障碍 在 WWID 中，该群体的参与度可能仍不理想。该方法的重现性 显着增加了该作品转化为其他环境的潜力。长期影响将是 通过提供艾滋病毒综合预防，减少艾滋病毒并改善艾滋病毒的健康结果 包括 PrEP 在内的干预措施。