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.

项目摘要/摘要 暴露前预防（PREP）是一种有前途的生物医学艾滋病毒预防策略，涉及使用 HIV负人的Emtricerabine/Tenofovir Disoproxal（FTC/TDF），以降低其患有其的风险 获取艾滋病毒。有证据表明，注射药物（WWID）的妇女不成比例地遭受艾滋病毒的攻击。 虽然PREP可以大大减少WWID中的艾滋病毒收购，但目前几乎没有知识 帮助解决该研究小组的准备准备挑战。拟议的研究将解决 我们通过评估提供预备护理的新方法的知识差距，即 包装准备，测试和治疗对基于社区注射器的性传播感染 交换计划（SEP）服务。理由是（1）SEP当前可能会提供处方 针对阿片类药物依赖性等其他疾病（例如丁丙诺啡）的药物和长期监测，因此 提供预备护理是成功完成的工作的自然扩展； （2）SEP是可行的 许多艾滋病毒未感染的WWID的访问点，他们被认为有资格在当前临床下进行PREP 准则； （3）在已经在WWID已使用和信任的设置中提供的准备干预措施将增加 摄取，依从性和保留率。注射器交换计划的包装准备护理非常高 创新的。据我们所知，这种方法尚未进行测试，并且可能代表了范式转变 在这个高度脆弱的人群中启用和鼓励妇女从事有效的生物医学艾滋病毒 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 与初级和次要注射器交换用户一起研究。通过半结构化和深入的访谈 基于脆弱人群的行为模型以及FTC的药物水平监控，我们将解决 以下具体目的：（1）描述WWID参与预先护理连续体（着重于关键 妇女可以脱离或需要额外支持才能保持护理的时刻。 （2）评估 WWID参与预科护理连续体的易感性，启用和需求相关的因素。 （3） 探索模型因素与WWID的决策和参与预备护理的能力相关联。 除非开发出新的与诊所无关的干预方法来针对发现的特定障碍 在WWID中，参与该小组可能会保持次优。这种方法的可重复性 显着提高了这项工作的转化为其他设置的潜力。长期影响将是 通过递送HIV预防艾滋病毒的艾滋病毒降低并改善了WWID的健康结果 包括准备的干预措施。