Strengthening the HIV prevention continuum using pharmacies

利用药房加强艾滋病毒预防连续性

• 批准号: 10619854
• 负责人: NATALIE D. CRAWFORD
• 金额: $ 78.59万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619854
• 关键词: AIDS prevention; Accounting; Acquired Immunodeficiency Syndrome; Adopted; Adoption; American; Attitude; Blood Pressure; COVID-19; Cholesterol; Client; Collaborations; Community Pharmacy; Community Surveys; Consolidated Framework for Implementation Research; Counseling; Development; Effectiveness; Engineering; Epidemic; Exploration, Preparation, Implementation, and Sustainment; Glucose; Goals; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV diagnosis; HIV risk; Health; Human immunodeficiency virus test; Hybrids; Individual; Infection; Interview; Knowledge; Methodology; Methods; Modeling; Neighborhoods; Persons; Pharmacy facility; Phase; Policies; Population; Preparation; Prevalence; Prevention; Primary Prevention; Readiness; Reporting; Research; Research Design; Resources; Risk Reduction; Self Efficacy; Service provision; Services; Source; Stigmatization; System; Testing; Training; Treatment outcome; United States; Variant; Viral Load result; Work; community engagement; community transmission; effectiveness outcome; effectiveness testing; effectiveness/implementation study; experience; health care availability; high risk population; hybrid type 1 design; hybrid type 1 study; implementation evaluation; implementation outcomes; implementation science; member; model development; multidisciplinary; online community; patient safety; phase 3 study; pre-exposure prophylaxis; prevent; prevention service; scale up; screening; service delivery; service uptake; social stigma; testing access; testing services; testing uptake; transmission process; virtual; willingness

ABSTRACT Early HIV diagnosis is an essential component of the strategy to End the HIV Epidemic (EHE). Yet, half of the nearly 40,000 Americans who test positive for HIV every year have late (stage 3 AIDS) infection, which results in higher community transmission and poorer treatment outcomes. In the United States South, where HIV is disproportionately impacted, 50% of HIV infections are undiagnosed. Infrequent or delayed HIV testing is most often due to poor healthcare access and stigmatizing attitudes about HIV that inhibit prevention and treatment seeking. Thus, increased HIV testing access and uptake is urgently needed to normalize HIV testing and direct individuals to pre-exposure prophylaxis (PrEP) if they test HIV negative or HIV treatment if they test HIV positive. To increase HIV testing access and uptake, we propose integrating HIV prevention services within community pharmacies located in neighborhoods with high HIV prevalence. Despite promising evidence of feasibility of pharmacy-based HIV testing, it is not widely available. In fact, most local pharmacy boards lack policy guidance on HIV testing being within their scope of practice. Our work has shown that HIV testing uptake in community pharmacies can be increased if it is offered with less stigmatized non-HIV-related services (e.g., COVID19, blood pressure, glucose, and cholesterol screening). But many community pharmacy staff report inadequate training as barriers to integrating HIV testing into the pharmacy work system. Therefore, to evaluate the implementation and effectiveness of HIV testing and prevention services within community pharmacies we propose a hybrid type 1 study design that aims to 1) Examine the policy-, pharmacy staff- and client-level barriers and facilitators of adopting HIV prevention services (e.g., HIV testing, PrEP referral, HIV treatment referral) in community pharmacies, 2) Develop and implement pharmacy staff HIV prevention service (e.g., HIV testing and counseling, PrEP referral, HIV treatment referral) trainings, and 3) Test the effects of integrating HIV prevention services in community pharmacies with existing non-HIV-related screenings versus those without on effectiveness and implementation outcomes. Guided by the Exploration, Preparation, Implementation, Sustainment framework, this study will include an exploration phase that examines the barriers and facilitators to pharmacy-based HIV prevention service provision across the US South using online surveys of community pharmacy staff (n=300), and in-depth interviews of Board of pharmacy members (n=16) and pharmacy staff (n=40). In the preparation phase, a virtual community pharmacy HIV prevention training will be developed and offered to 150 community pharmacy staff. Finally, in the implementation and sustainment phase, we will evaluate the acceptability and sustainment of the HIV prevention service delivery over 12 months in 10 community pharmacies (5 pharmacies who offer primary prevention screenings vs. 5 pharmacies who do not). Findings will be used to support scaling HIV prevention services in community pharmacies in the South where efforts to reduce HIV transmission are desperately needed to EHE.

摘要 早期艾滋病毒诊断是结束艾滋病毒流行战略的重要组成部分。然而， 每年有近40，000名艾滋病毒检测呈阳性的美国人患有晚期（3期艾滋病）感染， 社区传播率较高，治疗效果较差。在美国南部， 50%的艾滋病毒感染者没有得到诊断。艾滋病毒检测不频繁或延迟是最常见的原因。 这通常是由于医疗保健条件差以及对艾滋病毒的污名化态度阻碍了预防和治疗 寻找因此，迫切需要增加艾滋病毒检测的获得和接受，以使艾滋病毒检测正常化， 暴露前预防（PrEP），如果他们测试HIV阴性或HIV治疗，如果他们测试HIV 肯定的：第为了增加艾滋病毒检测的获得和接受，我们建议整合艾滋病毒预防服务， 在艾滋病高发区的社区药店里。尽管有希望 虽然没有证据表明基于药物的艾滋病毒检测的可行性，但这种方法并不普遍。事实上，大多数当地药店 董事会缺乏关于艾滋病毒检测在其业务范围内的政策指导。我们的研究表明， 如果社区药房提供的非艾滋病毒相关的污名较少， 服务（例如，COVID 19、血压、血糖和胆固醇筛查）。但许多社区药房 工作人员报告说，培训不足是将艾滋病毒检测纳入药房工作系统的障碍。因此，我们认为， 评估社区内艾滋病毒检测和预防服务的实施情况和成效 我们提出了一个混合型1研究设计，旨在1）检查政策-，药房工作人员-和 采用艾滋病毒预防服务的客户层面障碍和促进因素（例如，HIV检测、PrEP转诊、HIV 治疗转诊），2）发展和实施药房工作人员艾滋病毒预防服务 (e.g.,艾滋病毒检测和咨询、PrEP转介、艾滋病毒治疗转介）培训，以及3）测试 将社区药房的艾滋病毒预防服务与现有的非艾滋病毒相关筛查相结合， 而那些没有关于有效性和执行结果的建议。以探索、准备、 实施，可持续框架，这项研究将包括一个探索阶段，审查 在美国南部使用在线提供基于药物的艾滋病预防服务的障碍和促进因素 对社区药房工作人员（n=300）进行调查，并对药房委员会成员（n=16）进行深入访谈 和药房工作人员（n=40）。在准备阶段，虚拟社区药房开展了艾滋病预防培训 将开发并提供给150名社区药房工作人员。最后，在执行和 在维持阶段，我们将评估艾滋病毒预防服务的可接受性和可持续性 在10个社区药房（5个药房提供初级预防筛查，5个药房提供初级预防筛查） 药店不做）。调查结果将用于支持扩大社区艾滋病毒预防服务 在南部，迫切需要努力减少艾滋病毒传播的药店。