Determining the effectiveness of a new model of PrEP initiation in Mississippi

项目摘要/摘要 这项混合方法研究的总体目标是检查当天预暴露的有效性。 密西西比州杰克逊市的预防(PrEP)启动计划，并探索PrEP的障碍和促进者 在这种PrEP递送模式中的启动和保留。艾滋病毒仍然是美国的一个严重的公共卫生问题 在过去五年中，艾滋病毒发病率下降幅度最小。在以下方面存在很大差距 美国的艾滋病毒发病率和PrEP摄取率--按地理和种族/民族--已经持续了几十年。 密西西比州是联邦终止艾滋病毒流行(EHE)倡议确定的七个州之一 艾滋病的“地理热点”。多发性硬化症的新艾滋病毒诊断率在美国排名第六，在 密西西比州黑人比白人高八倍。在2018-2019年，我们发起了 由药剂师主导的杰克逊当天PrEP启动计划，以整合当时的当天PrEP启动 目的是促进在杰克逊的非临床环境中快速增加PrEP的摄入量。完毕 75%的被提供当天PrEP的人填写了处方，约一半的人与 持续的PrEP护理。该方案继续利用当地资金和来自EHE的新资源进行运作 可以被用来扩展快速PrEP。然而，模型证据基础中的漏洞限制了其可扩展性 其他地方。在这里，我们使用前瞻性和回溯性数据提出了一系列研究，这些研究将直接 告知是否应将资源分配给扩展快速PrEP或开发替代模式 准备送货。首先，我们将通过检查PrEP持久性和HIV来评估快速PrEP的有效性 通过快速PrEP启动PrEP的个体(N=121)与一组个体的发病率比较 世卫组织于2015-2019年在密歇根州杰克逊市以传统的“现状”诊所模式启动了PrEP(N=475)。我们 将使用处方填充数据来比较两组之间12个月的PrEP持久性。在子- 分析，我们将把人群限制在那些在启动PrEP(A组)后被诊断为性传播感染的人 持续感染艾滋病毒的高风险)，并比较PrEP的持久性。我们还将使用MS State HIV监测数据 比较两组人群的HIV发病率。第二，我们将进行10-15个一对一的定性 采访脱离PrEP护理的快速PrEP参与者，以调查障碍和 PrEP启动和坚持的促进者。我们将采访3-4名快速准备计划参与者，他们在 快速PrEP连续体的每一步(例如，填写处方、与临床护理的初始联系，以及 在PrEP护理中进行维护)。这些研究的结果将指导EHE资源的使用 快速PrEP或开发新的PrEP交付模式，可在低临床环境下操作 容量。

PROJECT SUMMARY/ABSTRACT The overall goal of this mixed-methods study is to examine the effectiveness of a same-day pre-exposure prophylaxis (PrEP) initiation program in Jackson, Mississippi, and to explore barriers and facilitators to PrEP initiation and retention in this model of PrEP delivery. HIV remains a critical public health problem in the United States (US), with minimal decreases in HIV incidence in the past five years. There are substantial disparities in HIV incidence and PrEP uptake in the US – by geography and race/ethnicity – that have persisted for decades. Mississippi is one of seven states identified by the federal Ending the HIV Epidemic (EHE) initiative as a “geographic hotspot” of HIV. MS has the sixth highest rate of new HIV diagnosis in the US, with the rate among Black Mississippians being eight times higher than White Mississippians. In 2018-2019 we initiated a pharmacist-led, same-day PrEP initiation program in Jackson to integrate same-day PrEP initiation at the time of HIV testing, with a goal of facilitating rapid increase of PrEP uptake in non-clinical settings in Jackson. Over 75% of individuals who were offered same-day PrEP filled the prescription and about half were linked into ongoing PrEP care. The program has continued operating with local funds, and new resources from the EHE could be leveraged to expand Rapid PrEP. However, gaps in the model's evidence base limit its scalability elsewhere. Here we propose a series of studies using prospective and retrospective data that will directly inform whether resources should be allocated to scaling-up Rapid PrEP or to developing alternative models of PrEP delivery. First, we will estimate the effectiveness of Rapid PrEP by examining PrEP persistence and HIV incidence among individuals who initiated PrEP via Rapid PrEP (N=121) compared to a group of individuals who initiated PrEP in a traditional “status quo” clinic-based model in Jackson, MS in 2015-2019 (N=475). We will use prescription fill data to compare the 12-month PrEP persistence between the two groups. In sub- analyses, we will restrict the population to those who were diagnosed with an STI after starting PrEP (a group at high ongoing risk of HIV) and compare PrEP persistence. We will also use MS State HIV surveillance data to compare HIV incidence between the two groups. Second, we will conduct 10-15 one-on-one qualitative interviews with Rapid PrEP participants who disengaged from PrEP care to investigate the barriers and facilitators to PrEP initiation and persistence. We will interview 3-4 Rapid PrEP participants who disengaged at each step of the Rapid PrEP continuum (e.g., filling the prescription, initial linkage to clinical care, and maintenance in PrEP care). Findings from these studies will direct the use of EHE resources to either scale-up Rapid PrEP or to develop new models of PrEP delivery that can be operationalized in settings of low clinical capacity.