PrEP uptake, adherence & retention for African American MSM in Mississippi

 描述(由申请人提供)：在南方腹地与男性发生性行为的年轻非裔美国男子(YMSM)受到艾滋病毒/艾滋病流行的不成比例的影响。一种名为暴露前预防(PrEP)的每日一次的药物(恩曲他滨/替诺福韦)可以极大地减少MSM中艾滋病毒的感染，但行为和社会挑战破坏了其最佳吸收、使用和疗效。这项由早期调查人员提出的建议开发和测试了一种试点干预措施，旨在提高密西西比州AA YMSM患者的PrEP依从性和保留率。这项研究的结果将被用来帮助确定预防干预的基本要素，以克服在AA YMSM中遵守和保留PrEP的障碍，并将根据与南方腹地非裔美国人男性相关的社会和卫生政策背景而独特地定制。2014年，为了应对南方腹地AA MSM对艾滋病毒预防服务的未得到满足的需求，我们小组在密西西比州杰克逊市建立了第一个PrEP项目。到目前为止，我们的临床和实施经验突出了阻碍PrEP护理中最佳PrEP遵守和保留的几个挑战和障碍，并告知以下具体目标：目标1：定性分析将探索：1)通过基于移动位置的手机和互联网应用程序(APP)与AA YMSM接触来改善PrEP摄取的可接受性(在杰克逊，MS的AA YMSM中近一半遇到性伴侣)；2)性危险行为，包括与在线与其他场所相遇的伴侣，应用程序的使用频率，以及来自特定地理区域的性行为相对于参与者居住的地方的比例；3)支持PrEP坚持和保留的潜在干预成分和相关内容的可接受性。结果将为南方AA YMSM制定特定背景的、真实世界的PrEP干预措施提供信息。目的2：对10名AA未感染HIV的YMSM进行保留并坚持非洲裔美国男性PrEP(RAMP)干预的开放试点评估。通过在六个月内实施、反馈和持续质量改进的迭代过程，我们将提高这一干预措施的可接受性和可行性。目的：对80例再生障碍性贫血(AA)未感染HIV的YMSM进行RAMP干预的先导性随机对照试验。参与者将被随机分配到坡道干预或标准护理臂。坡道干预将包括针对PrEP的患者援助服务和相关的后续护理，包括：加强咨询、预约提醒、帮助克服保险和其他PrEP相关服务的障碍，以及交通援助。主要结果将包括PrEP的依从性和在PrEP相关医疗护理中的保留。

 DESCRIPTION (provided by applicant): Young, African American men who have sex with men (YMSM) in the Deep South are disproportionately impacted by the HIV/AIDS epidemic. A once daily medication (emtricitabine/tenofovir) known as pre-exposure prophylaxis (PrEP) can dramatically reduce HIV acquisition among MSM but behavioral and social challenges undermine its optimal uptake, use and efficacy. This proposal by early stage investigators develops and tests a pilot intervention designed to enhance PrEP adherence and retention in care for AA YMSM in Mississippi. The findings of this research will be used to help define the essential elements of a prevention intervention to overcome barriers to PrEP adherence and retention in care among AA YMSM, and will be uniquely tailored to the social and health policy contexts relevant for African American men in the Deep South. In 2014, to respond to unmet need for HIV prevention services among AA MSM in the Deep South, our group established the first PrEP program in Jackson, Mississippi. Our clinical and implementation experience to date highlights several challenges and barriers that impede optimal PrEP adherence and retention in care for PrEP, and informed the following specific aims: Aim 1: Qualitative analyses will explore: 1) acceptability of improving PrEP uptake by engaging AA YMSM through mobile location-based phone and internet applications ("apps") (where nearly half of AA YMSM in Jackson, MS meet sexual partners); 2) sexual risk behaviors, including with partners met online vs. other venues, frequency of app use, and proportion of sexual encounters from specific geographical areas relative to where participants live; and 3) acceptability of potential intervention components and related content to support PrEP adherence and retention. Results will inform development of a context-specific, real-world PrEP intervention for AA YMSM in the South. Aim 2: To conduct an open pilot evaluation of the retain and adhere African American Men on PrEP (RAMP) intervention with up to 10 AA HIV-uninfected YMSM. Using an iterative process of implementation, feedback and continuing quality improvement over six months, we will improve acceptability and feasibility of this intervention. Aim 3: To conduct a pilot randomized control trial of the RAMP intervention among 80 AA HIV-uninfected YMSM. Participants will be randomized to either the RAMP intervention or a standard of care arm. The RAMP intervention will include patient assistance services for PrEP and related follow-up care, including: enhanced counseling, appointment reminders, assistance with overcoming insurance and other barriers to PrEP related services, and transportation assistance. Primary outcomes will include PrEP adherence and retention in PrEP related medical care.