Integrated PrEP Interventions for People Who Inject Drugs in Rural Kentucky

针对肯塔基州农村地区注射毒品者的综合 PrEP 干预措施

• 批准号: 10670122
• 负责人: HILARY L SURRATT
• 金额: $ 14.78万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10670122
• 关键词: AIDS prevention; Address; Administrator; Appalachian Region; Caring; Case Management; Client; Clinical; Collaborations; County; Data; Disease Outbreaks; Drug user; Education; Environment; Epidemic; Equipment; Evidence based intervention; Guidelines; HIV; HIV Infections; HIV diagnosis; Harm Reduction; Human immunodeficiency virus test; Incidence; Indiana; Individual; Infrastructure; Injecting drug user; Injections; Intervention; Interview; Kentucky; Knowledge; Literature; Location; Measures; Medical; Monitor; Needle-Exchange Programs; North Carolina; Participant; Pharmaceutical Preparations; Practical Robust Implementation and Sustainability Model; Prevention; Protocols documentation; Provider; Randomized; Risk; Rural; Rural Community; Rural Population; Service delivery model; Services; Site; Sterility; Structure; Syringes; Testing; United States; West Virginia; Woman; Work; acceptability and feasibility; barrier to care; brief intervention; clinical care; drug testing; evidence base; health care availability; high risk; high risk population; informant; injection drug use; men; new epidemic; novel; opioid epidemic; point of care; pre-exposure prophylaxis; prevention service; preventive intervention; primary outcome; risk perception; rural area; satisfaction; scale up; screening; service intervention; service providers; social stigma; stimulant use; tool; transmission process; uptake

ABSTRACT Rural areas in the United States are increasingly impacted by HIV, tied to the ongoing opioid epidemic, growing stimulant use, and widespread drug injection. Kentucky (KY) is among seven states identified with heavy rural HIV burden and increasing rates of new HIV diagnoses attributable to injection drug use. Rural HIV outbreaks among people who inject drugs (PWID) have occurred recently in KY’s neighboring states, highlighting the urgent need to implement proven HIV prevention and harm reduction strategies for PWID in KY’s rural areas. A key pillar of Ending the HIV Epidemic (EHE): A Plan for America is the prevention of new HIV infections through scale up of evidence-based interventions, including syringe service programs (SSPs) and Pre-exposure prophylaxis (PrEP). Our R21 in KY’s Appalachian region demonstrated consistent utilization of rurally located SSPs by high-risk PWID, making SSPs a critical venue to scale delivery of comprehensive HIV prevention services in rural areas. In a prior RCT conducted by the PI of this application, strengths-based case management (SBCM) interventions were shown to be effective in increasing HIV testing and overcoming barriers to medical care among people who use drugs. Building on this prior work and ongoing collaboration with rural SSPs in KY, this R34 will adapt and integrate a novel PrEP initiation intervention at point of care in rural SSPs, in two KY counties that are among the nation’s top 10 most vulnerable to HIV among PWID, and conduct a preliminary test of its efficacy. The Specific Aims are to: 1) Assess client, provider, organization, and structural-level facilitators and barriers to integration of a PrEP focused SBCM (SBCM-PrEP) intervention into routine SSP practice. Guided by the PRISM model, we will conduct semi-structured key informant interviews with PWID, clinical care and harm reduction service providers, and facility administrators in our targeted SSP implementation locations, to identify individual, organizational, and structural challenges and opportunities to adapt the SBCM-PrEP to enhance client acceptability, accessibility and compatibility with clinical workflow; 2) Adapt an evidence-based SBCM protocol to provide PrEP intervention services for PWID in SSP sites. Using in-depth interview data from Aim 1, we will adapt, refine and incorporate HIV prevention content most salient to PrEP care into the SBCM-PrEP, following the ADAPT ITT framework; and 3) Examine feasibility, acceptability and preliminary efficacy of the adapted SBCM- PrEP. 80 participants will be randomized into: CDC-PrEP (an in-use PrEP intervention based on CDC guidelines), or SBCM-PrEP. Primary outcomes include feasibility and acceptability (measured by intervention attendance, engagement, and satisfaction) during the active intervention period, and preliminary efficacy on PrEP initiation (measured by dispensed PrEP prescription) 3- and 6- months post-baseline. The proposed study fills a gap in evidence for PrEP studies among rural PWID by testing brief interventions that address both individual and structural challenges to PrEP uptake through an integrated, point of care service delivery model.

抽象的 美国的农村地区受艾滋病毒的影响越来越多，与正在进行的阿片类药物流行有关， 日益增长的兴奋剂使用和宽度药物注射。肯塔基州（肯塔基州）是七个国家之一 大量的艾滋病毒燃烧和增加归因于注射药物的新艾滋病毒诊断率的增加。乡村的 注射毒品（PWID）的艾滋病毒爆发最近发生在肯塔基州的邻国， 强调迫切需要在PWID KY的粗糙区域。结束艾滋病毒流行（EHE）的关键支柱：美国的计划是预防新的 艾滋病毒感染是通过规模扩大基于证据的干预措施，包括注射器服务计划（SSP） 和暴露前预防（PREP）。我们在肯塔基州阿巴拉契亚地区的R21表现出一致的利用 高风险PWID的大致位置SSP，使SSP成为扩展全面交付的关键场所 农村地区的艾滋病毒预防服务。在该应用程序的PI进行的先前的RCT中，基于优势 病例管理（SBCM）干预措施可有效增加HIV测试并克服 使用毒品的人中医疗保健的障碍。在这项先前的工作和持续的合作基础上 使用ky中粗糙的SSP，此R34将适应并整合一种新型的准备启动干预措施 在艰难的SSP中，在两个肯塔基州的县中，这是美国最容易遭受艾滋病毒的十大县之一 在PWID中，并对其有效性进行初步测试。具体目的是：1）评估客户， 提供者，组织和结构级别的促进者以及集成为准备的障碍 SBCM（SBCM-PREP）干预常规SSP实践。在棱镜模型的指导下，我们将进行 半结构化的主要线人采访PWID，临床护理和减少伤害服务提供商以及 我们目标的SSP实施地点中的设施管理员，以确定个人，组织和 结构性挑战和机会适应SBCM-PREP以增强客户的可接受性，可访问性 与临床工作流程的兼容性； 2）调整基于证据的SBCM协议以提供准备 SSP站点中PWID的干预服务。使用AIM 1的深入访谈数据，我们将适应，精炼 并在适应后将预防艾滋病毒预防内容纳入SBCM-PREP ITT框架； 3）检查适应的SBCM-的可行性，可接受性和初步效率 准备。 80名参与者将被随机分为：CDC-PREP（基于CDC的中使用准备干预措施 指南）或SBCM-PREP。主要结果包括可行性和可接受性（通过干预衡量 在积极干预期内出席，订婚和满意），以及对 预备计划（通过分配的准备处方衡量）3个月后3个月。提议 研究填补了通过测试简短的干预措施来解决两者的差距。 通过集成的，护理点的交付模型进行采用的个人和结构挑战。

项目成果

Pre-Exposure Prophylaxis Barriers, Facilitators and Unmet Need Among Rural People Who Inject Drugs: A Qualitative Examination of Syringe Service Program Client Perspectives.

• DOI: 10.3389/fpsyt.2022.905314
• 发表时间: 2022
• 期刊: FRONTIERS IN PSYCHIATRY
• 影响因子: 4.7
• 作者: Surratt, Hilary L.;Yeager, Hannah J.;Adu, Akosua;Gonzalez, Evelyn A.;Nelson, Elizabeth O.;Walker, Tamara
• 通讯作者: Walker, Tamara