Interest, Preference, and Uptake of Long Acting ART among PLWH in Florida

项目摘要 一种新批准的长效注射(LAI)形式的抗逆转录病毒疗法(ART)现已上市，并有几种 其他长效配方正在开发中。这些为实现雄心勃勃的目标提供了新的工具 在通过帮助更多艾滋病毒携带者来结束美国艾滋病毒流行的倡议中进行了描述 (PLWH)实现持久的病毒抑制。因为饮酒与服药依从性降低有关， 这些治疗可能对饮酒的PLWH特别有帮助。这些令人振奋的新消息的影响 治疗将与他们的吸收成正比，这将受到个人偏好和 系统性因素。以前的研究表明，人们对莱雅艺术有很高的兴趣，但总体上没有 考虑了可能阻碍LAI-ART吸收的系统性因素。拟议研究的长期目标 是为提高PLWH患者抗逆转录病毒治疗依从性的项目提供信息。为了帮助实现这一目标，这款F31的目标是 授予的目的是：1)确定哪些个人和人际层面的因素与对 PLWH每季度一次关于每日服药的LAI-ART，重点关注ART依从性较低的人群和- 风险饮酒，使用佛罗里达队列研究的现有数据；2)描述PLWH对长效的偏好 ART(LA-ART)配方，并确定哪些治疗属性通过实施 最佳-最佳离散选择实验，探索偏好是否因饮酒状况和病毒而异 抑制；以及3)对20名参与艾滋病毒药物治疗的利益相关者进行深入的定性访谈 采购和处方(例如，艾滋病毒护理提供者和临床医生管理员)，以深入了解他们的 对不同LA-ART配方的态度和处方偏好，这些是如何影响这些的 患者的酒精使用、系统水平的障碍和开LA-ART的促进者，以及这些访问可以如何进行 用于增加与酒精有关的护理的可及性。进行这项研究将帮助我发展交叉- 削减技能以实现我的长期职业目标，即设计计划以改善以下方面的健康结果 PLWH，尤其是那些通过以下方式饮酒的人：1)衡量个人偏好和决策 与健康有关，2)获得定性数据收集和分析方面的专业知识，3)获得更好的 了解与艾滋病毒治疗和药物使用有关的公共医疗融资，4)学习技能 与专业和职业发展相关，以及5)负责任的研究行为。这项研究将 利用正在进行的佛罗里达州队列研究，该研究正在招募不同的成年PLWH人群，以及 南方艾滋病毒和酒精研究联盟与佛罗里达州卫生部之间的合作 和艾滋病毒护理提供者。这些数据可以为资金分配和政策变化提供信息，以支持这些ART 偏好，并可推论到酒精和其他物质使用障碍的治疗，以帮助集中注意力 开发新药物或制定计划，以帮助更好地整合艾滋病毒护理和与酒精有关的问题 治疗。

Project Summary A newly approved long-acting injectable (LAI) form of antiretroviral therapy (ART) is now available, and several other long-acting formulations are in development. These provide new tools to achieve the ambitious goals described in the initiative to End the HIV Epidemic in the United States by helping more people living with HIV (PLWH) achieve durable viral suppression. Because alcohol use is associated with decreased adherence, these treatments may be especially helpful among PLWH who drink. The impact of these exciting new treatments will be proportional to their uptake, which will be affected by both individual preferences and systemic factors. Previous studies have shown high levels of interest in LAI-ART but have not generally accounted for systemic factors that may hinder LAI-ART uptake. The long-term goal of the proposed research is to inform programs to improve ART adherence for PLWH. To help achieve this goal, the aims of this F31 grant are to: 1) determine which individual- and interpersonal-level factors are associated with preferences for a quarterly LAI-ART over taking daily pills in PLWH, focusing on populations with lower ART adherence and at- risk drinking, using existing data from the Florida Cohort study; 2) describe PLWH’s preferences for long-acting ART (LA-ART) formulations and determine which treatment attributes drive these preferences by implementing a best-best discrete choice experiment and explore whether preferences vary by drinking status and viral suppression; and 3) to conduct in-depth qualitative interviews with 20 stakeholders involved in HIV medication procurement and prescribing (e.g., HIV-care providers and clinician administrators) to gain insight into their attitudes towards and prescribing preferences of different LA-ART formulations, how these are impacted by patients’ alcohol use, systems-level barriers and facilitators of prescribing LA-ART, and how these visits can be used to increase the accessibility of alcohol-related care. Conducting this study will help me develop cross- cutting skills to achieve my long-term career goals of designing programs to improve health outcomes for PLWH, especially those who drink by focusing on: 1) measuring of individual preferences and decision-making related to health, 2) obtaining expertise in qualitative data collection and analysis, 3) gaining a better understanding of public healthcare financing related to HIV treatment and substance use, 4) learning skills related to professional and career development, and 5) responsible conduct of research. This study will leverage the ongoing Florida Cohort study, which is enrolling a diverse population of adult PLWH, and collaborations between Southern HIV and Alcohol Research Consortium and the Florida Department of Health and HIV care providers. These data can inform funding allocation and policy changes to support these ART preferences and can be extrapolated to treatments for alcohol and other substance use disorders to help focus development of novel medications or develop programs to help better integrate HIV care and alcohol-related treatment.