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Despite an increasing armamentarium of behavioral and biomedical HIV prevention methods, since 2010 rates of new infection have remained around 40,000 annually. The demonstrated efficacy and subsequent approval of emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis (PrEP) for HIV by the FDA in 2012 was thought to represent a turning point that could significantly reduce the number of new infections. Since approval, the promise of PrEP as a transformative intervention has yet to be realized. Despite the implementation of systems for clinical evaluation for and initiation of PrEP by primary care providers, HIV specialists, and STI clinics, numerous barriers to PrEP expansion have been identified, including: 1) patient and provider lack of knowledge, 2) lack of access to medical care among high-risk individuals, 3) provider discomfort and inexperience with screening for risk behaviors, and 4) insurance and affordability. This proposal seeks to expand access to and engagement in PrEP among high risk individuals though an innovative delivery approach in the Emergency Department (ED) while addressing these four barriers.
Aim 1: Initiate a targeted ED-based PrEP screening program and optimize its feasibility and acceptability.
Aim 2: Pre-Exposure Prophylaxis Provision in the ED (PrEPPED) Trial:
Identify 40 PrEP eligible patients over a 12-month period who are interested in initiating PrEP in the ED. These patients will be offered immediate PrEP (iPrEP) initiation in the ED with facilitated linkage to comprehensive out-patient care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Immediate PreP initiation | Experimental | PreP screening program with immediate PrEP (iPrEP) initiation in the ED using a PrEP "starter pack" with facilitated linkage to care. |
|
| Out-patient care for PrEP initiation | Active Comparator | PrEP screening program with referral to out-patient care for PrEP initiation |
|
| PreP Screening Program | Experimental | Part 1: Targeted ED-based patients |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PrEP screening program | Other | ICAP Pre-Exposure Prophylaxis (PrEP) Screening for Substantial Risk and Eligibility tool |
|
| Measure | Description | Time Frame |
|---|---|---|
| Engagement in Care (Implementation Component) | Engagement is care is defined by attending at least 1 out-patient clinic appointment with a PrEP provider within 30-days of the ED visit. | 30 days post-ED visit |
| Number of Participants on PrEP Usage | 90 days |
| Measure | Description | Time Frame |
|---|---|---|
| PrEPPED Satisfaction and Acceptability Survey (RCT Component) | PrEPPED Satisfaction and Acceptability Survey is a patient satisfaction questionnaire was developed by the study team. It's a series of independent Likert questions from 1-6 addressing different aspects of the program. Full scale from 0 to 18, with higher score indicating more satisfaction. Satisfaction data were not collected at 30, 60, or 90 days. After study initiation, it was determined by the researchers that the satisfaction items were specific to the emergency department visit experience and not relevant to the follow-up period. Consequently, decision was made to not administer the follow-up satisfaction assessments, therefore, no data was collected so there is no data to report. |
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Inclusion Criteria:
PrEP screen group:
iPrep group:
Exclusion Criteria:
PrEP screen group:
iPrEP group:
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| Name | Affiliation | Role |
|---|---|---|
| Ethan Cowan, MD | Icahn School of Medicine at Mount Sinai | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mount Sinai Beth Israel Hospital | New York | New York | 10003 | United States |
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Of 1455 patients screened, 169 were eligible, 26 were randomized and received their assigned intervention.
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| ID | Title | Description |
|---|---|---|
| FG000 | Out-patient Care for PrEP Initiation | PrEP screening program with referral to out-patient care for PrEP initiation PrEP screening program: ICAP Pre-Exposure Prophylaxis (PrEP) Screening for Substantial Risk and Eligibility tool |
| FG001 | Immediate PreP Initiation | PreP screening program with immediate PrEP (iPrEP) initiation in the ED using a PrEP "starter pack" with facilitated linkage to care. PrEP screening program: ICAP Pre-Exposure Prophylaxis (PrEP) Screening for Substantial Risk and Eligibility tool PrEP starter pack: emtricitabine/tenofovir alafenamide or emtricitabine/tenofovir disoproxil |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Out-patient Care for PrEP Initiation | PrEP screening program with referral to out-patient care for PrEP initiation PrEP screening program: ICAP Pre-Exposure Prophylaxis (PrEP) Screening for Substantial Risk and Eligibility tool |
| BG001 | Immediate PreP Initiation |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Engagement in Care (Implementation Component) | Engagement is care is defined by attending at least 1 out-patient clinic appointment with a PrEP provider within 30-days of the ED visit. | Posted | Count of Participants | Participants | 30 days post-ED visit |
|
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not collected
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Out-patient Care for PrEP Initiation | PrEP screening program with referral to out-patient care for PrEP initiation PrEP screening program: ICAP Pre-Exposure Prophylaxis (PrEP) Screening for Substantial Risk and Eligibility tool |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Ethan Cowan, MD, MS, FACEP | Rutgers New Jersey Medical School | 917-447-4964 | ethan.cowan@rutgers.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 20, 2021 | Sep 25, 2025 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D000163 | Acquired Immunodeficiency Syndrome |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
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Part 1 of study will enroll 30 participants. Part 2 of study will enroll 40 participants
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| PrEP starter pack | Other | emtricitabine/tenofovir alafenamide or emtricitabine/tenofovir disoproxil |
|
| 30 days post-ED visit |
| The VSQ-9 is a Visit-specific Satisfaction Instrument (RCT Component) | The VSQ-9 is a visit-specific satisfaction instrument adapted by the American Medical Guidelines Regimen Information Program (GRIP) survey. GRIP guide is a self-report to assess PrEP adherence at 30-days post ED visit, with 6 categorical items: excellent, very good, good, fair, poor, and very poor. Because participants were not required to follow up at a single clinic, post-discharge care settings varied widely. The VSQ-9 assesses satisfaction with a specific clinical encounter, and applying it across multiple, non-standardized settings was deemed inappropriate and unlikely to yield interpretable data. Therefore, decision was made by the researcher to not administer the VSQ-9 at 30, 60, or 90 days. Consequently, no follow-up VSQ-9 data were collected so there is no data to report. | 30 days post-ED visit |
| CDC Sexual Behavior Questions (CSBQ) (RCT Component) | CDC Sexual Behavior Questions (CSBQ) to measure HIV risk behavior. CSBQ is a multi-tiered, gender-specific questionnaire developed by the Centers for Disease Control and Prevention HIV-STID Behavioral Surveillance Working Group. Three separate domains - Sexual Behavior, Drug-related HIV risk, and HIV testing. Responses are yes/no with no summation. Number of participants who engaged in unsafe sexual behavior, was under substance influence and who had a HIV test. | 30 days post-ED visit |
| Number of Participants of New STI Diagnoses (RCT Component) | Number of new STI diagnosis between day 1 (day after enrollment) and day 90 (final day of follow-up) broken down into days 1-30, 31-60, 61-90. | 30 days, 60 days, and 90 days post-ED visit |
| Number of Participants of New HIV Infection (RCT Component) | Number of new HIV diagnosis at 90-days after enrollment. This question was only asked for those individuals who had not been lost to follow-up. | 90 days post-ED visit |
PreP screening program with immediate PrEP (iPrEP) initiation in the ED using a PrEP "starter pack" with facilitated linkage to care. PrEP screening program: ICAP Pre-Exposure Prophylaxis (PrEP) Screening for Substantial Risk and Eligibility tool PrEP starter pack: emtricitabine/tenofovir alafenamide or emtricitabine/tenofovir disoproxil |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Highest level of education | Count of Participants | Participants |
|
| Estimated annual total income | Count of Participants | Participants |
|
| Past-year employment status | Count of Participants | Participants |
|
| Covered by health insurance/health plan | Count of Participants | Participants |
|
| Frequency of having run out of money for basic necessities in the past year | Count of Participants | Participants |
|
| Experiencing homelessness | Count of Participants | Participants |
|
| Current living situation | Count of Participants | Participants |
|
|
|
| Primary | Number of Participants on PrEP Usage | Posted | Count of Participants | Participants | 90 days |
|
|
|
| Secondary | PrEPPED Satisfaction and Acceptability Survey (RCT Component) | PrEPPED Satisfaction and Acceptability Survey is a patient satisfaction questionnaire was developed by the study team. It's a series of independent Likert questions from 1-6 addressing different aspects of the program. Full scale from 0 to 18, with higher score indicating more satisfaction. Satisfaction data were not collected at 30, 60, or 90 days. After study initiation, it was determined by the researchers that the satisfaction items were specific to the emergency department visit experience and not relevant to the follow-up period. Consequently, decision was made to not administer the follow-up satisfaction assessments, therefore, no data was collected so there is no data to report. | No protocol amendment was generated for this Outcome Measure. Although the outcome was prespecified in the initial protocol, the study team ultimately determined during implementation that the required data elements could not be collected reliably across sites. Because this decision did not alter the study intervention, eligibility criteria, procedures, or primary outcome, and because no participant-facing activities were affected, the team did not submit a formal protocol amendment at the time. | Posted | 30 days post-ED visit |
|
|
| Secondary | The VSQ-9 is a Visit-specific Satisfaction Instrument (RCT Component) | The VSQ-9 is a visit-specific satisfaction instrument adapted by the American Medical Guidelines Regimen Information Program (GRIP) survey. GRIP guide is a self-report to assess PrEP adherence at 30-days post ED visit, with 6 categorical items: excellent, very good, good, fair, poor, and very poor. Because participants were not required to follow up at a single clinic, post-discharge care settings varied widely. The VSQ-9 assesses satisfaction with a specific clinical encounter, and applying it across multiple, non-standardized settings was deemed inappropriate and unlikely to yield interpretable data. Therefore, decision was made by the researcher to not administer the VSQ-9 at 30, 60, or 90 days. Consequently, no follow-up VSQ-9 data were collected so there is no data to report. | No protocol amendment was generated for this Outcome Measure. Although the outcome was prespecified in the initial protocol, the study team ultimately determined during implementation that the required data elements could not be collected reliably across sites. Because this decision did not alter the study intervention, eligibility criteria, procedures, or primary outcome, and because no participant-facing activities were affected, the team did not submit a formal protocol amendment at the time. | Posted | 30 days post-ED visit |
|
|
| Secondary | CDC Sexual Behavior Questions (CSBQ) (RCT Component) | CDC Sexual Behavior Questions (CSBQ) to measure HIV risk behavior. CSBQ is a multi-tiered, gender-specific questionnaire developed by the Centers for Disease Control and Prevention HIV-STID Behavioral Surveillance Working Group. Three separate domains - Sexual Behavior, Drug-related HIV risk, and HIV testing. Responses are yes/no with no summation. Number of participants who engaged in unsafe sexual behavior, was under substance influence and who had a HIV test. | Posted | Count of Participants | Participants | 30 days post-ED visit |
|
|
|
| Secondary | Number of Participants of New STI Diagnoses (RCT Component) | Number of new STI diagnosis between day 1 (day after enrollment) and day 90 (final day of follow-up) broken down into days 1-30, 31-60, 61-90. | Number of new STI diagnosis between day 1 (day after enrollment) and day 90 (final day of follow-up) broken down into days 1-30, 31-60, 61-90. Number analyzed at each time differ due to participants being lost to follow-up. | Posted | Count of Participants | Participants | 30 days, 60 days, and 90 days post-ED visit |
|
|
|
| Secondary | Number of Participants of New HIV Infection (RCT Component) | Number of new HIV diagnosis at 90-days after enrollment. This question was only asked for those individuals who had not been lost to follow-up. | Number of new HIV diagnosis at 90-days after enrollment. This question was only asked for those individuals who had not been lost to follow-up. | Posted | Count of Participants | Participants | 90 days post-ED visit |
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | Immediate PreP Initiation | PreP screening program with immediate PrEP (iPrEP) initiation in the ED using a PrEP "starter pack" with facilitated linkage to care. PrEP screening program: ICAP Pre-Exposure Prophylaxis (PrEP) Screening for Substantial Risk and Eligibility tool PrEP starter pack: emtricitabine/tenofovir alafenamide or emtricitabine/tenofovir disoproxil | 0 | 0 | 0 | 0 | 0 | 0 |
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| D015229 |
| Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D012897 | Slow Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
| HIV testing |
|
| day 31 to day 60 |
|
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| day 61 to day 90 |
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