PrEP uptake, adherence & retention for African American MSM in Mississippi

PrEP 的摄取、依从性

• 批准号: 9141506
• 负责人: Philip Andrew Chan
• 金额: $ 26.61万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-07 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9141506
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; African American; Age; Anti-Retroviral Agents; Appointment; Area; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical; Counseling; Deep South; Development; Elements; Enrollment; Epidemic; Evaluation; Feedback; Frequencies; Gays; Guidelines; HIV; HIV Infections; Health Insurance; Health Policy; Hearing; Incidence; Individual; Insurance; Insurance Coverage; Internet; Intervention; Interview; Learning; Life; Location; Medical; Mississippi; Modality; Participant; Patients; Pharmaceutical Preparations; Prevention; Preventive Intervention; Process; Prophylactic treatment; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Risk; Risk Reduction; Services; Sexual Partners; Social Policies; Staging; Structure; Tenofovir; Testing; Time; Transportation; Travel; Treatment Efficacy; United States; Visit; Writing; arm; base; condoms; copayment; cost; emtricitabine; experience; follow-up; high risk; improved; informant; meetings; men; men who have sex with men; patient assistance; payment; pill; prevention service; primary outcome; programs; public health relevance; sex risk; sexual encounter; social; social stigma; standard of care; therapy design; uptake; young men who have sex with men

 DESCRIPTION (provided by applicant): Young, African American men who have sex with men (YMSM) in the Deep South are disproportionately impacted by the HIV/AIDS epidemic. A once daily medication (emtricitabine/tenofovir) known as pre-exposure prophylaxis (PrEP) can dramatically reduce HIV acquisition among MSM but behavioral and social challenges undermine its optimal uptake, use and efficacy. This proposal by early stage investigators develops and tests a pilot intervention designed to enhance PrEP adherence and retention in care for AA YMSM in Mississippi. The findings of this research will be used to help define the essential elements of a prevention intervention to overcome barriers to PrEP adherence and retention in care among AA YMSM, and will be uniquely tailored to the social and health policy contexts relevant for African American men in the Deep South. In 2014, to respond to unmet need for HIV prevention services among AA MSM in the Deep South, our group established the first PrEP program in Jackson, Mississippi. Our clinical and implementation experience to date highlights several challenges and barriers that impede optimal PrEP adherence and retention in care for PrEP, and informed the following specific aims: Aim 1: Qualitative analyses will explore: 1) acceptability of improving PrEP uptake by engaging AA YMSM through mobile location-based phone and internet applications ("apps") (where nearly half of AA YMSM in Jackson, MS meet sexual partners); 2) sexual risk behaviors, including with partners met online vs. other venues, frequency of app use, and proportion of sexual encounters from specific geographical areas relative to where participants live; and 3) acceptability of potential intervention components and related content to support PrEP adherence and retention. Results will inform development of a context-specific, real-world PrEP intervention for AA YMSM in the South. Aim 2: To conduct an open pilot evaluation of the retain and adhere African American Men on PrEP (RAMP) intervention with up to 10 AA HIV-uninfected YMSM. Using an iterative process of implementation, feedback and continuing quality improvement over six months, we will improve acceptability and feasibility of this intervention. Aim 3: To conduct a pilot randomized control trial of the RAMP intervention among 80 AA HIV-uninfected YMSM. Participants will be randomized to either the RAMP intervention or a standard of care arm. The RAMP intervention will include patient assistance services for PrEP and related follow-up care, including: enhanced counseling, appointment reminders, assistance with overcoming insurance and other barriers to PrEP related services, and transportation assistance. Primary outcomes will include PrEP adherence and retention in PrEP related medical care.

 描述（由申请人提供）：年轻的非洲裔美国人与男性发生性关系（YMSM）在南方腹地受到艾滋病毒/艾滋病流行病的不成比例的影响。一种被称为暴露前预防（PrEP）的每日一次药物（恩曲他滨/替诺福韦）可以显着减少MSM中的艾滋病毒感染，但行为和社会挑战破坏了其最佳吸收，使用和疗效。由早期阶段的研究人员提出的这一建议开发并测试了一项试点干预措施，旨在提高密西西比AA YMSM护理中的PrEP依从性和保留率。这项研究的结果将用于帮助确定预防干预的基本要素，以克服AA YMSM中PrEP依从性和保留护理的障碍，并将独特地针对南方腹地非洲裔美国人相关的社会和卫生政策背景。 2014年，为了应对南方腹地AA MSM中未满足的艾滋病毒预防服务需求，我们的团队在密西西比的杰克逊建立了第一个PrEP计划。我们迄今为止的临床和实施经验突出了阻碍最佳PrEP依从性和保留PrEP护理的几个挑战和障碍，并告知了以下具体目标：目标1：定性分析将探索：1）通过移动的基于位置的电话和互联网应用程序（“应用程序”）与AA YMSM接触，提高PrEP吸收率的可接受性（其中近一半的AA YMSM在杰克逊，MS满足性伴侣）; 2）性风险行为，包括与在线与其他场所，应用程序的使用频率，以及相对于参与者居住的特定地理区域的性接触比例;和3）潜在干预成分和相关内容的可接受性，以支持PrEP的依从性和保留。结果将为南方AA YMSM的特定背景，现实世界的PrEP干预措施的发展提供信息。目标二：对保留和坚持非裔美国男性PrEP（RAMP）干预进行开放性试点评估，最多10名AA HIV未感染的YMSM。我们将在六个月的时间里，通过实施、反馈和持续质量改进的迭代过程，提高这一干预措施的可接受性和可行性。目的3：在80例AA未感染HIV的YMSM中进行RAMP干预的先导性随机对照试验。参与者将被随机分配到RAMP干预或标准护理组。RAMP干预将包括PrEP和相关后续护理的患者援助服务，包括：加强咨询，预约提醒，帮助克服PrEP相关服务的保险和其他障碍，以及交通援助。主要结局将包括PrEP依从性和PrEP相关医疗护理的保留。