Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol

被引：14

作者：

Sharma, Malika ^{[1
,2
,3
]}

Chris, Allison ^{[4
]}

Chan, Arlene ^{[5
]}

Knox, David C. ^{[2
]}

Wilton, James ^{[6
]}

McEwen, Owen ^{[7
]}

Mishra, Sharmistha ^{[2
,8
,9
,10
]}

Grace, Daniel ^{[11
]}

Rogers, Tim ^{[12
]}

Bayoumi, Ahmed M. ^{[2
,8
,9
,13
]}

Maxwell, John ^{[14
]}

Shahin, Rita ^{[4
]}

Bogoch, Isaac ^{[2
,15
]}

Gilbert, Mark ^{[16
]}

Tan, Darrell H. S. ^{[1
,2
,8
,9
,15
]}

机构：

[1] St Michaels Hosp, Div Infect Dis, Toronto, ON, Canada

[2] Univ Toronto, Dept Med, Toronto, ON, Canada

[3] Maple Leaf Med Clin, Toronto, ON, Canada

[4] Toronto Publ Hlth, Toronto, ON, Canada

[5] Scarborough Sexual Hlth Clin, Toronto, ON, Canada

[6] Ontario HIV Treatment Network, Toronto, ON, Canada

[7] Gay Mens Sexual Hlth Alliance, Toronto, ON, Canada

[8] St Michaels Hosp, Ctr Urban Hlth Solut, Toronto, ON, Canada

[9] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[10] Univ Toronto, Inst Med Sci, Toronto, ON, Canada

[11] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[12] Canadian Treatment Informat Exchange CATIE, Toronto, ON, Canada

[13] St Michaels Hosp, Div Gen Internal Med, Toronto, ON, Canada

[14] AIDS Comm Toronto, Toronto, ON, Canada

[15] Univ Hlth Network, Div Infect Dis, Toronto, ON, Canada

[16] British Columbia Ctr Dis Control, Vancouver, BC, Canada

来源：

BMC HEALTH SERVICES RESEARCH | 2018年 / 18卷

基金：

加拿大健康研究院;

关键词：

HIV pre-exposure prophylaxis; Task shifting; Implementation science; Knowledge translation; HIV prevention; Men who have sex with men; Medical education; UNITED-STATES; CARE; MEN; PERFORMANCE; PROVIDERS; INFECTION; OPINIONS; STIGMA; CANADA;

D O I：

10.1186/s12913-018-3324-2

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Gay, bisexual and other men who have sex with men (gbMSM) in Canada continue to experience high rates of incident HIV. Pre-exposure prophylaxis (PrEP, the regular use of anti-HIV medication) reduces HIV acquisition and could reduce incidence. However, there are too few physicians with expertise in HIV care to meet the projected demand for PrEP. To meet demand and achieve greater public health impact, PrEP delivery could be 'decentralized' by incorporating it into front-line prevention services provided by family physicians (FPs) and sexual health clinic nurses. Methods: This PrEP decentralization project will use two strategies. The first is an innovative knowledge dissemination approach called 'Patient-Initiated CME' (PICME), which aims to empower individuals to connect their family doctors with online, evidence-based, continuing medical education (CME) on PrEP. After learning about the project through community agencies or social/sexual networking applications, gbMSM interested in PrEP will use a uniquely coded card to access an online information module that includes coaching on how to discuss their HIV risk with their FP. They can provide their physician a link to the accredited CME module using the same card. The second strategy involves a pilot implementation program, in which gbMSM who do not have a FP may bring the card to designated sexual health clinics where trained nurses can deliver PrEP under a medical directive. These approaches will be evaluated through quantitative and qualitative methods, including: questionnaires administered to patients and physicians at baseline and at six months; focus groups with patients, FPs, and sexual health clinic staff, and review of sexual health clinic charts. The primary objective is to quantify the uptake of PrEP achieved using each decentralization strategy. Secondary objectives include a) characterizing barriers and facilitators to PrEP uptake for each strategy, b) assessing fidelity to core components of PrEP delivery within each strategy, c) measuring patient-reported outcomes including satisfaction with clinician-patient relationships, and d) conducting a preliminary costing analysis. Discussion: This study will assess the feasibility of a novel strategy for disseminating knowledge about evidence-based clinical interventions, and inform future strategies for scale-up of an underutilized HIV prevention tool.

引用

页数：10

共 50 条

[1]

[Anonymous], 2013, HIV AIDS ONTARIO PRE

[2]

[Anonymous], 2014, HIV AIDS CAN SURV RE

[3]

[Anonymous], PREEXP PROPH PREV HI

[4]

[Anonymous], 2008, TASK SHIFT GLOB REC

[5] A Qualitative Study of Provider Thoughts on Implementing Pre-Exposure Prophylaxis (PrEP) in Clinical Settings to Prevent HIV Infection [J].

Arnold, Emily A. ;

Hazelton, Patrick ;

Lane, Tim ;

Christopoulos, Katerina A. ;

Galindo, Gabriel R. ;

Steward, Wayne T. ;

Morin, Stephen F. .

PLOS ONE, 2012, 7 (07)

[6] Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women [J].

Baeten, J. M. ;

Donnell, D. ;

Ndase, P. ;

Mugo, N. R. ;

Campbell, J. D. ;

Wangisi, J. ;

Tappero, J. W. ;

Bukusi, E. A. ;

Cohen, C. R. ;

Katabira, E. ;

Ronald, A. ;

Tumwesigye, E. ;

Were, E. ;

Fife, K. H. ;

Kiarie, J. ;

Farquhar, C. ;

John-Stewart, G. ;

Kakia, A. ;

Odoyo, J. ;

Mucunguzi, A. ;

Nakku-Joloba, E. ;

Twesigye, R. ;

Ngure, K. ;

Apaka, C. ;

Tamooh, H. ;

Gabona, F. ;

Mujugira, A. ;

Panteleeff, D. ;

Thomas, K. K. ;

Kidoguchi, L. ;

Krows, M. ;

Revall, J. ;

Morrison, S. ;

Haugen, H. ;

Emmanuel-Ogier, M. ;

Ondrejcek, L. ;

Coombs, R. W. ;

Frenkel, L. ;

Hendrix, C. ;

Bumpus, N. N. ;

Bangsberg, D. ;

Haberer, J. E. ;

Stevens, W. S. ;

Lingappa, J. R. ;

Celum, C. .

NEW ENGLAND JOURNAL OF MEDICINE, 2012, 367 (05) :399-410

[7]

Canadian Agency for Drugs and Technologies in Health, 2016, CDTH CAN GRUG EXP CO

[8]

College of Physicians and Surgeons of Ontario, 2012, DEL CONTR ACTS POL S

[9]

DAVIS DA, 1995, JAMA-J AM MED ASSOC, V274, P700

[10] The problem of "us" versus "them" and AIDS stigma [J].

Devine, PG ;

Plant, EA ;

Harrison, K .

AMERICAN BEHAVIORAL SCIENTIST, 1999, 42 (07) :1212-1228

← 1 2 3 4 5 →