Characterizing the HIV pre-exposure prophylaxis care continuum for African American and Hispanic/Latino men who have sex with men

项目摘要 年轻的非洲裔美国人（AA）和西班牙裔/拉丁裔（H/L）男男性行为者承担了不成比例的艾滋病毒份额 美国（US）的疾病负担。暴露前预防（PrEP）在减少艾滋病毒方面非常有效 艾滋病毒感染的风险，但它的能力，以减少艾滋病毒感染的AA和H/L男男性接触者取决于 最佳实施和在“真实世界”临床环境中的扩展使用。初步研究表明， AA和H/L启动PrEP，并以低于白色对应者的比率保留在PrEP护理中，但几乎没有 了解AA和H/L MSM在PrEP护理中的长期坚持和保留。的方式 哪些结构、社会和个人层面的因素会影响真实世界环境中的PrEP结果， 在年轻的AA和H/L MSM中，尚未得到很好的理解。开始PrEP的MSM可能会改变行为 (e.g.,与HIV阴性伴侣建立一夫一妻制关系），不再适用PrEP。 此外，很大程度上还不清楚为什么个人，特别是AA和H/L MSM，没有保留在PrEP护理中 这使得制定适当的干预措施以提高PrEP护理的保留率变得复杂。这一拟议 一项研究遵循了一个纵向观察性队列（n=450）的白色，AA和H/L MSM在现实世界的PrEP 计划在密西西比，密苏里州，和罗得岛都表征一个PrEP护理连续性和预测 为什么男男性接触者是次优的坚持或失去照顾，重点是衡量种族和民族差异 （具体目标1）。我们将与男男性接触者进行个别访谈，他们是规定的PrEP，但次优 坚持或退出PrEP护理（具体目标2），以阐明次优坚持的原因， 保留，并确定潜在干预措施的组成部分，以提高护理的依从性和保留率。 使用我们的纵向队列的数据，我们将在基于代理的环境中进行微观模拟。 模型，以评估次优PrEP依从性和保留护理对三个国家艾滋病毒发病率的影响。 不同的美国设置。然后，我们将预测潜在干预措施对PrEP护理连续体的影响 具体目标（3）。

PROJECT SUMMARY Young African American (AA) and Hispanic/Latino (H/L) MSM bear a disproportionate share of the HIV disease burden in the United States (US). Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV acquisition risks among MSM, but its ability to reduce HIV acquisition among AA and H/L MSM hinges on optimal implementation and expanded use in “real-world” clinical settings. Preliminary studies demonstrate that AA and H/L initiate PrEP and are retained in PrEP care at lower rates than their White counterparts, but little is known about longer-term adherence and retention in PrEP care among AA and H/L MSM. The manner in which structural, social, and individual level factors impact PrEP outcomes in real-world settings, particularly among young AA and H/L MSM, are not yet well understood. MSM who initiate PrEP may change behaviors (e.g., enter a monogamous relationship with an HIV negative partner) and no longer be indicated for PrEP. Furthermore, it is largely unknown why individuals, especially AA and H/L MSM, are not retained in PrEP care which complicates development of appropriate interventions to enhance retention in PrEP care. This proposed study follows a longitudinal, observational cohort (n=450) of White, AA and H/L MSM in real-world PrEP programs in Mississippi, Missouri, and Rhode Island to both characterize a PrEP care continuum and predict why MSM are sub-optimally adherent or lost to care, with a focus on measuring racial and ethnic disparities (Specific Aim 1). We will conduct individual interviews with MSM who are prescribed PrEP but sub-optimally adherent or drop out of PrEP care (Specific Aim 2) to elucidate reasons for sub-optimal adherence and retention and to identify components of potential interventions to improve adherence and retention in care. Using data from our longitudinal cohort, we will perform microsimulations in the context of an agent-based model to evaluate the impact of sub-optimal PrEP adherence and retention in care on HIV incidence in three diverse US settings. We will then predict the impact of potential interventions on PrEP care continuum outcomes (Specific Aim 3).