Advancing pre-exposure prophylaxis (PrEP) access in pharmacies to improve PrEP uptake in disadvantaged areas

推动药房提供暴露前预防 (PrEP)，以提高贫困地区的暴露前预防 (PrEP) 利用率

• 批准号: 10215269
• 负责人: NATALIE D. CRAWFORD
• 金额: $ 15.68万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10215269
• 关键词: AIDS prevention; AIDS/HIV problem; Appointment; Area; Behavioral; Biological; Businesses; Caring; Clinical; Communication; Community Pharmacy; Continuing Education; Counseling; Creatinine; Data; Development; Diagnosis; Disadvantaged; Environment; Feasibility Studies; Foundations; Goals; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; Health; Health Services; Human Resources; Improve Access; Incidence; Intervention; Interview; Learning; Link; Location; Modeling; Neighborhoods; Nurse Practitioners; Patient Self-Report; Pharmacists; Pharmacy facility; Phase; Physicians; Pilot Projects; Population; Poverty; Privatization; Randomized; Regulation; Research; Resources; Risk; Safety; Sexually Transmitted Diseases; Side; Site; Source; Stigmatization; Structure; Surveys; Test Result; Testing; Time; Training; Trust; United States National Institutes of Health; Vaccination; Vulnerable Populations; Work; base; black men who have sex with men; cost; data format; design; distrust; efficacy trial; follow-up; high risk behavior; improved; innovation; interest; men; men who have sex with men; pre-exposure prophylaxis; prevention service; programs; racial disparity; racial minority; satisfaction; screening; service delivery; social; social stigma; statistics; theories; therapy development; uptake

Abstract Optimizing the reach of pre-exposure prophylaxis (PrEP) access for black men who have sex with men (BMSM) is critical to reduce racial inequities in HIV. The overall objective of this R34 application is to develop a culturally appropriate pharmacy PrEP delivery model and examine its feasibility, acceptability, and safety for BMSM who live in high poverty, racial minority neighborhoods. Cohen’s structural theory supports our central hypothesis that increased availability of PrEP screening and prescribing in neighborhoods where BMSM are most impacted by HIV will facilitate PrEP uptake. Findings from the proposed pilot study will support the long- term goal of this program of research, which is to implement an R01 cluster randomized efficacy trial in high poverty, racial minority neighborhoods to increase PrEP uptake among BMSM and reduce racial inequities in HIV. The aims of this R34 feasibility study are to: Aim 1) develop a pharmacy PrEP delivery model by evaluating the barriers to and facilitators of integrating PrEP into existing pharmacy practice among 40 key stakeholders (pharmacists, technicians, PrEP-prescribing physicians and BMSM) and Aim 2) pilot test the pharmacy PrEP delivery model and examine its feasibility, acceptability and safety, and gather early evidence of its impact and cost with respect to PrEP uptake at baseline and in 3-months among BMSM. To accomplish these aims we will conduct a formative phase of in-depth interviews among key stakeholders to inform the intervention development phase, which will establish a pharmacy PrEP delivery model with formalized input from an existing advisory board to be implemented in the pilot study phase among 2 community pharmacies, where we have existing relationships. Pharmacists (n=2) and technicians (n=6) will be trained using an adapted continuing education certified in-pharmacy HIV prevention training. They will complete semi-structured surveys over time (baseline, 3-month and 6-month) to assess the impact of the pharmacy PrEP intervention on pharmacy environment, personnel, and business flow. Social, behavioral surveys will be completed by 60 BMSM. We will follow behaviorally eligible BMSM, who complete their own biological screening in the pharmacy and receive PrEP (n=20) to determine PrEP uptake at 3-months. Development and refinement of this pharmacy PrEP delivery model is significant because it will lay the foundation for pharmacy-based PrEP access that reaches populations historically disconnected from HIV prevention resources. The innovation of this studies lies in its ability to shift the current paradigm of PrEP service delivery for BMSM by 1) creating a model that is achievable for most pharmacists even if they have limited pharmacy-level resources to screen men for PrEP, 2) employing a multi-level approach that examines the impact of the intervention on pharmacy staff and BMSM and 3) testing the use of self-screening in the pharmacy setting.

摘要 优化黑人男男性接触者暴露前预防(PrEP)的覆盖范围 (Bmsm)对于减少艾滋病毒中的种族不平等至关重要。这个R34应用程序的总体目标是开发一个 文化上合适的药房PrEP交付模式，并检查其可行性、可接受性和安全性 生活在高度贫困、少数族裔社区的BMSM。科恩的结构理论支持我们的中央 假设在BMSM存在的社区增加PrEP筛查和处方的可用性 受艾滋病毒影响最大的将促进PrEP的吸收。拟议的先导研究结果将支持长期的- 本研究计划的长期目标是在HIGH中实施R01整群随机疗效试验 贫困、少数族裔社区增加BMSM的PrEP接种率并减少种族不平等 爱滋病毒。这项R34可行性研究的目的是：目标1)通过以下方式开发药房PrEP交付模式 评估40个关键因素中将PrEP整合到现有药学实践中的障碍和促进者 利益相关者(药剂师、技术人员、开PrEP处方的医生和BMSM)和AIM 2)试点测试 药房PrEP交付模式，并检查其可行性、可接受性和安全性，并收集早期证据 在基线和3个月内BMSM对PrEP摄取量的影响和成本。要完成 为了实现这些目标，我们将在关键利益攸关方中进行深入访谈的形成阶段，以向 干预开发阶段，将建立具有正式输入的药房PrEP交付模型 从两家社区药房将在试点研究阶段实施的现有咨询委员会， 在那里我们有现有的关系。2名药剂师和6名技术员将接受培训 适应继续教育认证的药房艾滋病毒预防培训。他们将完成半结构化 一段时间内(基线、3个月和6个月)的调查，以评估药房PrEP干预对 药房环境、人员和业务流程。社会、行为调查将在60年前完成 BMSM。我们将跟踪符合行为条件的BMSM，他们在 药房和接受PrEP(n=20)，以确定PrEP摄取在3个月。开发和完善 这种药房PrEP交付模式意义重大，因为它将为基于药房的PrEP奠定基础 能够接触到历来与艾滋病毒预防资源隔绝的人群。创新之处 这项研究在于它有能力通过1)创建一个 大多数药剂师即使只有有限的药房级别资源进行筛选也可以实现的模式 男性接受PrEP，2)采用多层次方法检查干预对药房的影响 工作人员和BMSM以及3)在药房环境中测试自我筛选的使用。