Hybrid Evaluation of the Implementation and Effectiveness of Home-based HIV Pre-exposure Prophylaxis Monitoring in King County, Washington
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 458
- 试验地点
- 2
- 主要终点
- PrEP retention
研究概览
简要总结
The study's aim is to implement a home-based PrEP (HB-PrEP) monitoring system (self-collected blood and extragenital specimens at home and telehealth follow-up) into a large, urban sexual health clinic while also evaluating the program's clinical effectiveness. Study participants will self-collect blood specimens using Tasso devices, which are currently designated as FDA Class 2 exempt medical devices (similar to a medical lancet). This study will be integrated into King County's Ending the HIV Epidemic plan and generate data to inform refinement, adaptation and scale-up of future HB-PrEP programs.
Specific research aims are to:
- Conduct a hybrid randomized trial to compare the impact of a HB-PrEP program versus standard of care (routine in-clinic monitoring) on PrEP retention over time and use mixed-methods assessments to define the factors that influence HB-PrEP implementation. Hypothesis: HB-PrEP will increase PrEP retention rates by >10% at 18 months and 60% of those offered HB-PrEP will use it for over half of visits.
- Perform a cost analysis of the HB-PrEP implementation strategy compared to standard care. Hypothesis: HB-PrEP cost will fall within the HIV prevention budget and be affordable with comparable costs to SOC.
- Develop a qualitative tool to engage healthcare stakeholders and determine the wider scalability of HB-PrEP.
详细描述
Pre-exposure prophylaxis (PrEP) is an established and effective method for HIV prevention, but lack of access to PrEP providers and the burden of quarterly monitoring visits remain barriers to PrEP uptake and retention, particularly for people of color and younger men who have sex with men (MSM). Home-based PrEP (HB-PrEP) monitoring could unburden medical systems and increase PrEP access, but whether this remote care option improves key clinical outcomes like PrEP retention is not known.
The study's specific aims are to:
- AIM 1: Evaluate the impact of HB-PrEP on PrEP retention and define the factors that influence HB-PrEP implementation. The investigators will conduct a type 1 hybrid randomized controlled trial comparing HB-PrEP as an implementation strategy (self-collected lab specimens from home and telehealth follow-up) to standard of care (SOC) at the Public Health-Seattle & King County (PHSKC) Sexual Health Clinic (SHC). The study's primary outcome will be effectiveness of the implementation strategy measured as the rate of retention in PrEP care. In secondary analyses, investigators will utilize mixed methods to assess reach (proportion of persons offered HB-PrEP who choose to use it), and examine individual-level barriers and facilitators (B&F) to PrEP retention (participant surveys and interviews) and system-level B&F to HB-PrEP implementation (participant surveys and interviews, PHSKC staff interviews). Hypothesis: HB-PrEP will increase PrEP retention rates by >10% at 18 months and 60% of those offered HB-PrEP will use it for over half of visits.
- AIM 2: Perform a cost analysis of HB-PrEP service implementation at the PHSKC SHC compared to SOC. Investigators will track resource use and prospectively collect unit costs for laboratory fees, healthcare worker time and other clinic resources to estimate the total monthly cost of providing HB-PrEP services overall and the monthly cost per person retained in PrEP care in the HB-PrEP and SOC arms. Hypothesis: HB-PrEP cost will fall within the HIV prevention budget and be affordable with comparable costs to SOC.
- AIM 3: Conduct a HB-PrEP scale-up assessment with healthcare organizations (HCO) and other key stakeholders to determine the scalability of HB-PrEP within Washington State. To evaluate institution-level factors that may impede or facilitate statewide HB-PrEP scale-up, investigators will conduct semi-structured interviews with key stakeholders from a countywide EHE HCO collaborative.
The Aim 1 study is a pragmatic, non-blinded, hybrid type 1 (clinical-implementation) RCT and includes mixed-methods assessments to evaluate both qualitative and quantitative data for the primary and secondary outcomes. Aim 3 is a qualitative study using in-depth interviews.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Must be eligible to receive PrEP per PHSKC criteria
- •Age ≥18 years
- •Washington State resident
- •Ability to speak, understand and read/write in English or Spanish
- •Willing to provide contact information
- •Willing to be randomized and adhere to study procedures
排除标准
- •Recent (<4 weeks) "high risk" HIV exposure while off PrEP or symptoms of acute HIV
- •No mailing address to receive sampling kits
- •No working telephone number
- •No smartphone or other device with internet access
- •History of a bleeding disorder, or current or recent (≤7 days) use of anticoagulant medications
- •Pregnancy
结局指标
主要结局
PrEP retention
时间窗: 18 months
Proportion of participants who successfully complete triannual monitoring tests and visits to receive a renewed PrEP prescription
次要结局
- PrEP adherence(Every 4 months up to 16 months and at study exit (on/after 18 months))
- Reach(18 months)
- User satisfaction(Every 4 months up to 16 months and at study exit (on/after 18 months))
- Barriers and facilitators of PrEP retention(Every 4 months starting at month 4 until target of 24 reached)
- Cost(Month 12 through study completion, an average of 6 months)
- Time to action on abnormal results(Every 4 months up to 16 months and at study exit (on/after 18 months))
- STI positivity rate(Every 4 months up to 16 months and at study exit (on/after 18 months))
研究者
Chase Cannon
Assistant Professor, School of Medicine
University of Washington