Developing and assessing the feasibility of a home-based PrEP support program

描述（由申请人提供）：2006-2009年，美国男男性行为者（MSM）之间的性传播占HIV感染事件的大部分。暴露前化学预防（PrEP）已被证明可减少44%的艾滋病毒感染事件，提供了大量的公共卫生机会。接受PrEP的男性必须至少每季度进行一次监测，包括艾滋病毒和性传播感染的实验室检测、药物依从性和风险行为评估，并在必要时与咨询联系。目前，男性必须去找他们的医生才能获得这种服务，这一制度给医生和病人都带来了很大的负担。如果在美国将PrEP扩大到符合条件的高危男男性行为者，我们估计每年将需要数百万患者就诊。拟议的研究旨在通过开发基于家庭的监测和支持系统，使PrEP的扩大更加可行。基于家庭的系统可以减轻患者和提供者的负担，增加患者接受或继续接受PrEP的意愿，促进非专业人员提供PrEP护理，并且是一个节省成本的项目。我们建议进行定性的，形成性的工作来开发基于家庭的PrEP监测系统，该系统将包括：(1)使用邮寄工具包自行采集标本；(2)在线智能手机或短信评估药物依从性和性行为风险；(3)视频/电话咨询支持。在开发了PrEP监测和支持系统之后，我们的目标是在旧金山、波士顿和亚特兰大的一群正在接受PrEP治疗的男男性行为者中进行试点。

DESCRIPTION (provided by applicant): Sexual transmission among men who have sex with men (MSM) accounted for the majority of incident HIV infections in the United States from 2006-2009. Preexposure chemoprophylaxis (PrEP) has been shown to reduce incident HIV infection by 44%, providing a substantial public health opportunity. Men on PrEP are required to have a least quarterly monitoring that includes laboratory testing for HIV and sexually transmitted infections, medication adherence and risk behavior assessments, and linkage with counseling, if needed. Currently, men must visit their providers for such services, a system that places a large burden on both providers and patients. If PrEP were to be scaled up to cover eligible, high-risk MSM in the United States, we estimate that millions of yearly patient visits would be required. The proposed research seeks to make PrEP scale-up more feasible, by developing a home-based monitoring and support system. A home-based system could have the benefits of decreasing patient and provider burdens, increasing patient willingness to undergo or remain or PrEP, facilitating the provision of PrEP care by non-specialists, and being a cost-saving program We propose to conduct qualitative, formative work to develop a home-based PrEP monitoring system that would consist of (1) specimen self-collection using mail-in kits; (2) online smartphone or SMS assessment of medication adherence and sexual behavior risk; and (3) video/telephone counseling support. After development of the PrEP monitoring and support system, we aim to pilot the program with a group of MSM currently on PrEP regimens in San Francisco, Boston and Atlanta.