Promoting PrEP Adherence for Men Who Have Sex with Men of Color: More Options, Less Barriers

项目总结 与有色人种发生性关系的年轻男性(YMSM)继续经历不成比例的艾滋病毒感染率 与美国(美国)其他人群的感染情况进行比较。尽管每天都有高效的 口服HIV暴露前预防(PrEP)，YMSM对PrEP的吸收和依从性仍然较低。数据 支持YMSM对探索不同剂量和递送策略表现出兴趣，这些策略可能转化为 更多地采用PrEP，特别是在那些坚持每日养生法没有成功的人中。 循证提供者和患者教育和支持工具(EBT)是可用的，但不是 常规用于临床环境，以增加PrEP筛查、咨询、启动、依从性和 YMSM的坚持。到目前为止，还缺乏关于现有EBT对 准备供应，或如何定制这些材料以满足不同供应商和YMSM的需求 背景可以增强它们的效果。此外，可用的EBT不承认或并入 关于不断增长的预防产品武器库的信息，也没有最大限度地增加参与的机会 关于这些产品的共享决策(SDM)流程。我们的跨学科专家团队建议 调整和加强现有的EBT，以促进PrEP SDM，培训供应商使用EBT，并评估 在种族和地理上不同的YMSM纵向队列中的影响。我们的应用程序依赖于 作为实施框架的探索、准备、实施和维持(EPIS)模式 用于研究将这些工具整合到现实世界的临床环境中。在目标1中，我们将进行迭代 与提供者和患者一起进行形成性评估，以告知现有患者的适应和增强 和提供商PrEP EBT。调查结果将为现有EBT的适应和完善提供信息，这将是 在实施之前，通过咨询性研讨会与供应商和基督教青年会反复审查。在AIM 2、我们将培训供应商使用新开发的基于量身定做的励志访谈的EBT (TMI)培训模式，这是一种可扩展、集中化、文化和发展量身定做的模式，具有 显示了对自主性、支持性和减少交流的污名的影响。不同类型的供应商 临床站点将参加一个虚拟培训研讨会，然后是基于能力的电子教练。培训 将重点实施EBT，以确保提高他们从事PrEP筛查的能力， 辅导、启蒙，并为坚持和坚持提供支持。在目标3中，我们将测试新的 通过实施混合型2型有效性-实施务实临床来开发/改进EBT 试验(N=540名18至39岁的青年男性接触者)以评估有效性和实施结果。一个完全发达的 经过验证的基于移动应用的平台支持持续的参与者参与和监控。我们的研究 建立在我们现有的基础设施之上，支持严格的临床试验、mHealth工具、实施 科学，以及对受影响人口和社区倡导者的了解和联系。

PROJECT SUMMARY Young men who have sex with men (YMSM) of color continue to experience disproportionate rates of HIV infection compared to other groups in the United States (US). Despite the availability of highly effective daily oral HIV pre-exposure prophylaxis (PrEP), uptake and adherence to PrEP among YMSM remains low. Data support that YMSM show interest in exploring different dosing and delivery strategies which may translate into greater uptake of PrEP, particularly among those have not been successful adhering to a daily regimen. Evidence-based provider and patient education and support tools (EBT) are available but are not being routinely used in clinical settings to increase PrEP screening, counseling, initiation, adherence, and persistence by YMSM. To date, there has been a lack of research on the impact that existing EBT have on PrEP provision, or how tailoring these materials to meet the needs of providers and YMSM from diverse backgrounds could enhance their effects. Further, available EBT do not acknowledge or incorporate information about a growing arsenal of prevention products nor are they maximizing opportunities to engage in a shared decision-making (SDM) process about these products. Our interdisciplinary team of experts proposes to adapt and enhance existing EBT to facilitate PrEP SDM, train providers on the use of the EBT and evaluate the impact within a longitudinal cohort of racially and geographically diverse YMSM. Our application relies upon the Exploration, Preparation, Implementation, and Sustainment (EPIS) model as the implementation framework for studying the integration of these tools into real-world clinical settings. In aim 1, we will conduct an iterative formative assessment with providers and patients to inform adaptation and enhancement of existing patient and provider PrEP EBT. Findings will inform the adaptation and refinement of existing EBT which will be iteratively reviewed with providers and YMSM through Consultative Workshops prior to implementation. In aim 2, we will train providers on use of newly developed EBT grounded in the Tailored Motivational Interviewing (TMI) training model, a scalable, centralized, culturally and developmentally tailored model that has demonstrated impacts on autonomy supportive and stigma reducing communication. Providers at diverse clinical sites will participate in a virtual training workshop, followed by competency-based eCoaching. Training will focus on implementation of the EBT to ensure increases in their ability to engage in PrEP screening, counseling, initiation, and provide support for adherence and persistence. In aim 3, we will test the newly developed/refined EBT through the conduct of a hybrid type 2 effectiveness-implementation pragmatic clinical trial (N=540 YMSM ages 18 to 39) to assess effectiveness and implementation outcomes. A fully-developed and validated mobile app-based platform supports ongoing participant engagement and monitoring. Our study builds on our existing infrastructure that supports the rigorous clinical trials, mHealth tools, implementation science, and knowledge of, and linkages with, affected populations and community advocates.