Next generation partner notification and intervention services

描述(由申请人提供)：本开发申请(R34)要求资金完善和试点灵活的伙伴通知服务暴露前预防(PS-PrEP)干预措施，该干预措施将使现有的公共卫生部(DPH)合作伙伴通知服务与临床PrEP护理联系起来，为来自不同背景的艾滋病毒血清阴性高危人群提供护理。之所以需要这些资金，是因为在随机对照试验之后，仍然存在明显的疗效实施分歧，这些试验证明了PrEP的部分疗效。在这些试验之后，DPH尚未将PrEP纳入现有的艾滋病毒预防计划，导致PrEP的患者很少，而那些可能受益最大的人(最高风险人群)没有获得PrEP。为了弥补这些差距，我们的目标是将PrEP整合到现有的DPH活动中，特别是DPH合作伙伴通知服务中。由疾病干预专家(DIS)实施的DPH合作伙伴通知服务在国内艾滋病毒高发地区普遍存在，具有巨大的潜力。合作伙伴通知服务(聘用新感染艾滋病毒者的风险伙伴)，是疾控中心为预防艾滋病毒而推荐的，并经常由公共卫生部门进行。在来自南芝加哥的数据中，这些风险接触者中超过50%是艾滋病毒感染者。这一高艾滋病毒流行率超过了同一地理区域的传统风险群体，并表明我们应该将我们对谁是PrEP关联的合适候选者的思维从个人风险(肛交、注射毒品)转移到网络风险(与艾滋病毒感染者有关联的人)。PS-PrEP通过培训DIS工作人员来测试PrEP与常规DPH服务的集成，以提供简短的定制PrEP联系计划/动机，通过文本/电话进行小型助推器会议，并直接将客户与PrEP护理联系起来。PS-PrEP将通过检查早期PrEP护理的两个关键组成部分，为大规模试验奠定基础：1)PS-PrEP将高危血清阴性患者与PrEP护理联系起来，作为合作伙伴通知服务的一部分；以及2)个人特征(例如，风险行为)和 通过合作伙伴通知服务确定的研究参与者的下游PrEP级联指标(例如，对PrEP的保留率和依从性)与具有相同临床背景和时间框架的其他启动PrEP的个人进行比较。我们的目标是：1)完善PS-PrEP干预方案、材料和评估，将更多的干预转移到直接PrEP联系上，并开发一个网络可视化组件，参与者在其中完成自己风险网络中个人的互动社会图；2)在从合作伙伴通知服务机构招募的18岁接触者样本中，在随机化后3个月进行PS-PrEP干预的可行性(反应、采用、安全性和实施)和初始有效性(与护理的更高联系)与通常治疗相比的初步测试；3)比较与PrEP护理相关的PS-PrEP干预参与者与在相同临床背景和时间范围内(12个月)启动PrEP的其他个人的社会人口学、HIV风险和两个远端PrEP级联指标(保留率和依从性)。

DESCRIPTION (provided by applicant): This developmental application (R34) requests funds to refine and pilot test a flexible Partner notification services Pre-exposure Prophylaxis (PS-PrEP) intervention that will engage existing department of public health (DPH) partner notification services in linkage to clinical PrEP care for at risk HIV seronegative persons from diverse backgrounds. These funds are requested because there remains a stark efficacy implementation divide following randomized controlled trials which have demonstrated partial PrEP efficacy. Following these trials, DPHs have yet to integrate PrEP into existing HIV prevention programs resulting in few people on PrEP and those who might benefit most (highest risk populations) are not receiving it. To address these gaps, we aim to integrate PrEP into existing DPH activities, and in particular, DPH partner notification services. DPH partner notification services implemented by Disease Intervention Specialists (DIS) are widespread in high HIV prevalence areas domestically and have great potential. Partner notification services (engaging the risk partners of newly infected HIV persons), is recommended by the CDC for HIV prevention and is frequently conducted by public health departments. In data from South Chicago over 50% of these risk contacts are HIV infected. This high HIV prevalence outpaces that of traditional risk groups in the same geographic area and suggests that we shift our thinking of who an appropriate candidate for PrEP linkage is from individual risk (anal sex, injecting drugs), to network risk (people connected to HIV infected persons). PS-PrEP tests the integration of PrEP into routine DPH services by training DIS staff to provide brief tailored PrEP linkage planning/motivation, mini-booster sessions via text/phone, and to directly link clients int PrEP care. PS-PrEP will set the stage for a large trial by examining two key components of early PrEP care: 1) efficacy of PS-PrEP in linking high-risk seronegative clients to PrEP care as part of partner notification services; and 2) how personal characteristics (e.g. risk behavior) and downstream PrEP cascade metrics (e.g. retention and adherence to PrEP) of study participants identified through partner notification services compare to other individuals initiating PrEP withi the same clinical context and time frame. We aim to: 1) Refine the PS-PrEP intervention protocol, materials and assessments by shifting more of the intervention to focus on direct PrEP linkage and by developing a network visualization component where participants complete an interactive sociogram of individuals in their own risk network; 2) Pilot test the feasibility (reac, adoption, safety and implementation) and initial efficacy (higher linkage to care) of the PS-PrEP intervention versus treatment as usual at 3 months post randomization among a sample of contacts >18 years old recruited from partner notification services; and 3) Compare sociodemographic, HIV risk and two distal PrEP cascade metrics (retention and adherence) of PS-PrEP intervention participants linked to PrEP care with other individuals initiating PrEP within the same clinical context and time frame (12 months).