Pickering Eleanor, Viera Adam, Sung Minhee L, Davidson Daniel, Bailey Genie, Buchelli Marianne, Jenkins Mark, Kolakowski Jennifer, Maier Leah, Edelman E Jennifer, Rash Carla J
Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, 06510, USA.
Yale University School of Nursing, 06477, Orange, CT, USA.
Addict Sci Clin Pract. 2024 Dec 23;19(1):97. doi: 10.1186/s13722-024-00503-4.
Contingency management (CM), an incentive-based intervention to encourage target behaviors, effectively promotes medication adherence. However, efforts to extend CM to HIV pre-exposure prophylaxis (PrEP) have been lacking. As part of a randomized clinical trial to promote HIV Prevention among people who inject drugs (PWID), we examined the readiness of staff in community-based organizations serving PWID to implement CM for PrEP uptake and adherence in this population.
From April to August 2022, we conducted a survey of staff from four community-based organizations providing HIV testing, harm reduction, and outreach services in the northeastern United States. We assessed knowledge and attitudes regarding PrEP for PWID on five-point Likert scales (e.g., Poor to Excellent, Not at all to Extremely). Using a modified version of the Contingency Management Beliefs Questionnaire, we assessed the degree to which attitudes about CM for HIV prevention influenced interest in its adoption on a scale from "1-No influence at all" to "5-Very strong influence". We explored endorsement patterns, along with average values of individual items and subscale scores.
Among 271 staff invitations, 123 (45.4%) responded. The majority (88.6%) of respondents reported prior PrEP awareness, with a mean self-rated knowledge of 2.98 out of 5 (SD = 1.1). Attitudes towards PrEP, including its relevance to and importance for clients (both means = 4.3), efficacy (mean = 4.5), and safety (mean = 4.2), were positive. Items related to practicality and confidence in providing PrEP-related care had relatively lower ratings. Respondents endorsed influential generalized (mean = 2.1) and training-related (mean = 2.5) CM implementation barriers less frequently than positive attitudes towards CM (mean = 3.6). Staff favored adding CM to existing services (mean = 3.8), and highly endorsed it as "useful for targeting HIV prevention with PrEP" (mean = 3.7).
Respondents generally supported the use of CM to promote HIV prevention among PWID and favored adding it to their existing services. Though respondents understood the value of both PrEP and CM to support HIV prevention activities, findings corroborate research citing relative lack of knowledge and confidence regarding PrEP management among clients, potentially detracting from implementation readiness.
NCT04738825.
应急管理（CM）是一种基于激励的干预措施，旨在鼓励目标行为，能有效提高药物依从性。然而，将CM扩展至HIV暴露前预防（PrEP）的相关努力一直欠缺。作为一项在注射吸毒者（PWID）中促进HIV预防的随机临床试验的一部分，我们调查了为PWID提供服务的社区组织工作人员对在该人群中实施CM以促进PrEP使用和依从性的准备情况。
2022年4月至8月，我们对美国东北部四个提供HIV检测、减少伤害及外展服务的社区组织的工作人员进行了一项调查。我们用五点李克特量表（如，差到优、一点也不了解到非常了解）评估了他们对PWID的PrEP的知识和态度。我们使用应急管理信念问卷的一个修改版本，从“1 - 完全没有影响”到“5 - 影响非常大”的量表评估关于HIV预防的CM态度对采用CM的兴趣的影响程度。我们探讨了认可模式，以及各个项目和子量表分数的平均值。
在271份工作人员邀请中，123人（45.4%）做出了回应。大多数（88.6%）受访者表示之前了解PrEP，自我评定的知识平均得分为5分中的2.98分（标准差 = 1.1）。对PrEP的态度是积极的，包括其与客户的相关性和重要性（平均分均为4.3）、有效性（平均分 = 4.5）和安全性（平均分 = 4.2）。与提供PrEP相关护理的实用性和信心相关的项目评分相对较低。受访者认可有影响力的一般性（平均分 = 2.1）和与培训相关的（平均分 = 2.5）CM实施障碍的频率低于对CM的积极态度（平均分 = 3.6）。工作人员赞成在现有服务中增加CM（平均分 = 3.8），并高度认可其“对以PrEP为目标进行HIV预防有用”（平均分 = 3.7）。
受访者普遍支持使用CM在PWID中促进HIV预防，并赞成将其添加到现有服务中。尽管受访者理解PrEP和CM对支持HIV预防活动的价值，但研究结果证实了相关研究指出的客户对PrEP管理相对缺乏知识和信心，这可能会影响实施准备情况。
NCT04738825。
