RP1 Screen 2 Prevent

项目总结 在美国，青少年和青壮年(Aya)受艾滋病毒的影响不成比例。尽管青少年 占新感染人数的20%以上，这一年龄段最不可能接受艾滋病毒检测，与护理有关， 与成年同龄人相比，实现了病毒抑制。此外，阿亚的艾滋病毒感染率也很低。 暴露前预防(PrEP)的意识和接受。因此，迫切需要扩大艾滋病毒 针对非传统医疗机构(如急诊科)的筛查和预防策略 接触到阿亚，否则她就不会得到预防性医疗保健。此应用程序的目标是 利用我们从多中心、以ED为基础的青少年淋病和衣原体感染获得的最新见解 筛查研究，以确定最临床和最具成本效益的艾滋病病毒筛查方法，将 对高危青年也使用数字健康和快速启动PrEP或抗逆转录病毒治疗(ART)。这将是 通过青少年医学艾滋病毒/艾滋病干预试验网络(ATN)利用 其基础设施包括地理上不同的站点财团，包括青少年诊所和他们的 相关的儿科急救人员。这项研究将有助于为创造临床有效的、 成本效益高、可持续的艾滋病毒筛查计划，可以成功地实施到临床 教育署的工作流程。它还将改善对高危青少年的识别和与PrEP/ART护理的联系 使用mHealth策略，首先根据Aya对以下问题的反应确定哪些Aya是PrEP/ART候选对象 计算机化的性健康筛查(CSHS)，随后为 提供者通过电子健康记录和教育信息通过短信直接发送到PrEP/ART 候选人根据他们的艾滋病毒检测结果。这种干预将依赖于一种创新的方法，即电子 整合患者报告的数据以指导CDS。这项工作意义重大，因为它有可能填补 文献需要提供证据，证明在儿科急诊室进行HIV筛查的最佳方法。第一, 我们将进行有针对性的艾滋病毒筛查的务实比较有效性试验(仅筛查 披露高危性行为)与普遍提供的艾滋病毒筛查(选择加入和选择退出方法 提供给所有人，而不考虑风险)通过电子集成患者报告数据以提供CDS和 PrEP候选资格的确认。根据艾滋病毒检测结果，我们将利用数字健康来实现状态中立 快速或当天的mHealth PrEP/ART Start(SMART)和与护理的联系。这项研究是新颖的，因为它改变了 儿科急诊室HIV筛查和预防的常规临床实践范例 采取一致和可持续的办法，这对解决阿亚人中的艾滋病毒流行至关重要。

PROJECT SUMMARY Adolescents and young adults (AYA) are disproportionately affected by HIV in the US. Despite adolescents accounting for over 20% of new infections, this age group is the least likely to be tested for HIV, linked to care, and achieve viral suppression as compared to their adult counterparts. Further, AYA also have low rates of HIV Pre-Exposure Prophylaxis (PrEP) awareness and uptake. Therefore, there is an urgent need to expand HIV screening and prevention strategies to nontraditional healthcare settings such as emergency departments (ED) to reach AYA who would otherwise not receive preventive healthcare. The goal of this application is to leverage our recent insights obtained from a multi-center, ED-based, adolescent gonorrhea and chlamydia screening study to determine the most clinically and cost-effective HIV screening approach for AYA that will also use digital health and rapid start PrEP or antiretroviral therapy (ART) for at risk youth. This will be accomplished through the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) by leveraging its infrastructure which includes geographically diverse site consortiums including adolescent clinics and their associated pediatric EDs. This research will contribute to the evidence base for creating clinically effective, cost-effective, and sustainable HIV screening programs that can be successfully implemented into the clinical workflow of the ED. It will also improve identification and linkage to PrEP/ART care for at risk adolescents using mHealth strategies by first identifying AYA who are PrEP/ART candidates based on their responses to a computerized sexual health screen (cSHS) and subsequently providing clinical decision support (CDS) to providers via the electronic health record and educational information by text message directly to PrEP/ART candidates based on their HIV results. This intervention will rely on an innovative approach that electronically integrates patient-reported data to guide CDS. This work is significant because it has the potential to fill gaps in the literature needed to provide evidence for the best method of HIV screening in a pediatric ED setting. First, we will conduct a pragmatic comparative effectiveness trial of targeted HIV screening (screening only those disclosing high risk sexual behavior) versus universally offered HIV screening (both opt-in and opt-out methods offered to all, regardless of risk) through electronic integration of patient reported data for provision of CDS and identification of PrEP candidacy. Based on HIV test results, we will then harness digital health for status neutral rapid or same-day mHealth PrEP/ART start (SMART) and linkage to care. This research is novel in that it shifts the usual clinical practice paradigm of HIV screening and prevention in the pediatric ED from a scattered approach to a consistent and sustainable approach that is critical to addressing the HIV epidemic among AYA.