Advancing PrEP in pharmacies COVID supplement

摘要 优化与男性发生性关系的黑人男性接触前预防（PrEP）的覆盖范围 （BMSM）是减少艾滋病毒种族不平等的关键。此R34应用程序的总体目标是开发一个 文化上适当的药房PrEP交付模式，并检查其可行性，可接受性和安全性， 生活在高度贫困的少数民族社区的BMSM。科恩的结构理论支持了我们的核心观点， 假设增加了PrEP筛查的可用性，并在BMSM所在的社区开处方， 大多数受艾滋病毒影响的人将促进PrEP的吸收。拟议试点研究的结果将支持长期的 这项研究计划的长期目标，这是实施一项R01集群随机疗效试验，在高 贫困，少数民族社区，以增加BMSM之间的PrEP吸收和减少种族不平等， 艾滋病。本R34可行性研究的目的是：目的1）通过以下方式开发药房PrEP交付模式 评估将PrEP纳入现有药房实践的40个关键因素中的障碍和促进因素 利益相关者（药剂师，技术人员，PrEP处方医生和BMSM）和目标2）试点测试 药房PrEP提供模式，并检查其可行性，可接受性和安全性，并收集早期证据 它的影响和成本方面的准备摄取在基线和3个月的BMSM。完成 这些目标，我们将在关键利益相关者中进行深入访谈的形成阶段， 干预开发阶段，该阶段将建立具有正式输入的药房PrEP交付模型 从现有的咨询委员会将在试点研究阶段在2个社区药房中实施， 我们现有的关系。药剂师（n=2）和技术员（n=6）将使用 经过调整的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 随着时间的推移（基线，3个月和6个月）进行调查，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岁之前完成 BMSM。我们将跟踪行为合格的BMSM，他们在 药房和接受PrEP（n=20），以确定在3个月的PrEP吸收。制定和完善 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 向历史上与艾滋病毒预防资源脱节的人群提供服务。的创新 这项研究在于它能够通过以下方式改变目前为BMSM提供PrEP服务的模式：1）创建一个 这是一个模式，是可以实现的大多数药剂师，即使他们有有限的药房级资源筛选 2）采用多层次的方法，检查干预对药房的影响 工作人员和BMSM和3）测试使用的自我筛选在药房设置。

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.