A randomized clinical trial of client-centered care coordination to improve pre-exposure prophylaxis use for Black men who have sex with men

项目摘要 鉴于黑人男男性行为者中艾滋病毒感染率仍然不成比例 (MSM)，公共卫生迫切需要确定可扩展的干预措施，以支持面临 艾滋病毒决定采取暴露前预防(PrEP)，帮助获得PrEP，并坚持PrEP。目前， 黑人男男性接触者感染HIV的比率在美国最高，但PrEP的比率最低 利用率。支持使用这种救命药物的创新方法很少，也没有可用的方法 很少经过严格的测试。早期研究表明，一种干预措施具有潜在的积极作用 影响以病人为中心的护理协调(C4)干预模式。C4在NIH资助的HIV中进行了试验 预防试验网络(HPTN)073研究显示了希望，但需要更多的评估来评估 并利用这种干预。这项研究的目的是促进在HPTN 073中所做的关于 C4在华盛顿特区和纽约市的真实临床环境中。目标1将确定 C4在黑人MSM中增加PrEP依从性，Aim 2将确定C4的最佳剂量 最大限度地提高遵守PrEP的效果的实施，目标3将描述可接受性和 在社区环境中实施C4的可行性。这项研究的发现将有助于美国国立卫生研究院 减少艾滋病毒发病率的优先事项以及利用执行科学作出贡献的交叉领域 有助于我们理解护理和减少医疗保健差距的结构性和心理社会障碍。

Project Abstract In view of the continued disproportionate rates of HIV infection among Black men who have sex with men (MSM), there is an urgent public health need to identify scalable interventions to support Black MSM at risk of HIV to decide to take pre-exposure prophylaxis (PrEP), help access PrEP, and adhere to PrEP. Currently, Black MSM have the highest rates of HIV acquisition in the United States yet have the lowest rates of PrEP utilization. Innovative methods to support use of this lifesaving medication are few and those that are available are seldom rigorously tested. One intervention demonstrated in early studies to have potential for positive impact a client-centered care coordination (C4) intervention model. C4 was piloted in the NIH-funded HIV Prevention Trials Network (HPTN) 073 study and showed promise, yet more evaluation is required to assess and leverage this intervention. The aims of this study are to further the work done in HPTN 073 with regard to C4 in real-world clinical settings in Washington, DC and in New York City. Aim 1 will determine the efficacy of C4 for increasing PrEP adherence among Black MSM, Aim 2 will identify the optimal dose of C4 implementation for maximizing its effect on PrEP adherence, and Aim 3 will d Describe the acceptability and feasibility of C4 implementation in community settings. Findings from this study will contribute to the NIH priorities to reduce HIV incidence as well as cross-cutting areas of using implementation science to contribute to our understanding of structural and psychosocial barriers to care and reduction of healthcare disparities.