Optimizing HIV prevention for highly vulnerable methamphetamine-using sexual minority men

优化对高度脆弱的使用甲基苯丙胺的性少数男性的艾滋病毒预防

• 批准号: 10462053
• 负责人: Adam Wayne Carrico
• 金额: $ 195万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-08 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10462053
• 关键词: AIDS prevention; Address; Behavior; Biological; Caring; Clinical; Complex; Continuity of Patient Care; Effectiveness; Enrollment; Epidemic; Funding; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Human immunodeficiency virus test; Hybrids; Immune; Incentives; Incidence; Intervention; Laws; Methamphetamine; Methodology; Motivation; Participant; Peer Review; Pharmaceutical Preparations; Policies; Prevalence; Randomized Controlled Trials; Readiness; Reporting; Risk; Role; Sampling; Science; Social Network; Telephone; Testing; Toxicology; aged; biobehavior; chemokine; clinically relevant; cohort; comorbidity; comparative; contingency management; cytokine; density; design; digital; effectiveness testing; ethnic minority; evidence base; high risk; implementation science; men of color; methamphetamine use; methamphetamine user; motivational enhancement therapy; people of color; pre-exposure prophylaxis; primary outcome; prospective; psychologic; psychosocial; public health intervention; racial and ethnic; racial disparity; recruit; rectal; response; sexual minority; sexual minority group; sexual minority men; social; social determinants; social stigma; sound; success; syndemic; telehealth; transmission process; virtual

SUMMARY This LITE-2 (RFA-AI-21-018) initiative responds to a resurgent epidemic of methamphetamine (meth) use in sexual minority men (SMM), which is a primary driver of HIV incidence. The overarching goals are two-fold: 1) identify multi-level and bio-behavioral determinants of amplified HIV seroconversion risk in meth-using SMM; and 2) test the effectiveness of telehealth motivational enhancement interventions for optimizing entry or re-entry of SMM who use meth into the PrEP care continuum. Findings from our LITE-1 cohort (UG3/UH3 AI-133675, RFA-AI-16-031) and others provide compelling evidence that meth use is increasing, disproportionally impacts racial/ethnic minorities, and accounts for one-in-three new HIV infections in SMM. In response to LITE-2 (RFA- AI-21-018) we propose a multi-component initiative zeroing in on the “Where,” “How,” and “Why” of meth use and HIV risk. Where: What are the geospatial determinants of the association of meth use with HIV incidence? How: How can we support (re-)entry into the PrEP care continuum with this high priority population of SMM who use meth? Why: Does meth amplify biological risk of HIV by potentiating rectal immune dysregulation? Aim 1: Examine multi-level structural, psychological, and social determinants of amplified HIV seroconversion risk in SMM who use meth. The centerpiece of our LITE-2 initiative is a new prospective, bio-behavioral cohort with N=5,000 SMM (n=3,000 SMM who use meth, n=2,000 who do not). Participants will complete assessments over 36 months and provide biological samples for HIV testing, drug toxicology testing, rectal STIs, and rectal cytokines/chemokines. Our primary goal will be to investigate the role of geospatial determinants (e.g., background meth and HIV prevalence, urbanicity) and other structural determinants (e.g., structural stigma of sexual minorities as evidenced by policies/laws) in relation to the association of meth use with amplified HIV seroconversion risk. Aim 2: Test the comparative and combined effectiveness of telehealth motivational enhancement interventions for optimizing PrEP use. PrEP Readiness Interventions for Supporting Motivation (PRISM) is a hybrid type I, modified factorial randomized controlled trial (RCT) of telehealth CM that provides incentives for filling a PrEP prescription, and a 2-session telehealth MI intervention that we adapted with meth- using SMM (R34-DA046367, Carrico/Grov). PRISM will enroll 840 meth-using SMM who are not currently taking PrEP from the LITE-2 cohort (Aim 1) to examine the effectiveness of CM (n = 280), MI (n = 280), and MI+CM (n = 280) on the primary outcome – filling a PrEP prescription. Aim 3: Determine whether greater rectal immune dysregulation partially explains amplified risk of HIV seroconversion in SMM who use meth. Using a case-cohort design, we will compare HIV seroconverters (n=450) with matched seronegative controls (n=450) to examine the clinical relevance of meth-induced alterations in rectal cytokines with respect to HIV seroconversion. This LITE-2 initiative could have an exceptional impact by transforming HIV prevention with SMM.

概括 这项 LITE-2 (RFA-AI-21-018) 举措旨在应对甲基苯丙胺 (meth) 使用的重新流行。 性少数男性 (SMM) 是艾滋病毒发病率的主要驱动因素，总体目标有两个： 1) 确定使用冰毒的 SMM 中 HIV 血清转化风险放大的多层次和生物行为决定因素； 2) 测试远程医疗动机增强干预措施对于优化进入或重新进入的有效性 将冰毒纳入 PrEP 护理连续体的 SMM 的调查结果来自我们的 LITE-1 队列 (UG3/UH3 AI-133675， RFA-AI-16-031）和其他人提供了令人信服的证据，表明冰毒的使用正在增加，影响不成比例 少数族裔/族裔，占 SMM 中三分之一的新艾滋病毒感染者 根据 LITE-2 (RFA-) AI-21-018）我们提出了一项多组成部分的倡议，重点关注冰毒使用的“地点”、“方式”和“原因” 哪里：冰毒使用与艾滋病毒发病率之间的关系的地理空间决定因素是什么？ 如何：我们如何支持（重新）进入 PrEP 护理连续体，这些 SMM 的高优先级人群 使用冰毒？ 原因：冰毒是否会通过加剧直肠免疫失调来放大艾滋病毒的生物学风险？ 检查艾滋病毒血清转化风险放大的多层次结构、心理和社会决定因素 使用冰毒的 SMM 我们的 LITE-2 计划的核心是一个新的前瞻性生物行为队列。 N=5,000 名 SMM（n=3,000 名使用冰毒的 SMM，n=2,000 名不使用冰毒的 SMM）。 36个月并提供生物样本用于HIV检测、药物毒理学检测、直肠性传播感染、直肠 我们的主要目标是研究地理空间决定因素的作用（例如， 背景冰毒和艾滋病毒流行率、城市化）和其他结构性决定因素（例如，结构性污名） 政策/法律所证明的性少数群体）与冰毒使用与艾滋病毒扩增的关联 目标 2：测试远程医疗激励的比较和综合有效性。 优化 PrEP 使用的增强干预措施 支持动机的 PrEP 准备干预措施。 (PRISM) 是远程医疗 CM 的混合型 I 型改良析因随机对照试验 (RCT)，它提供 填写 PrEP 处方的激励措施，以及我们采用方法进行调整的 2 次远程医疗 MI 干预措施 使用 SMM（R34-DA046367，Carrico/Grov）将招募 840 名目前未服用冰毒的 SMM。 来自 LITE-2 队列（目标 1）的 PrEP 用于检查 CM (n = 280)、MI (n = 280) 和 MI+CM (n = 280) 主要结果 – 填写 PrEP 处方 目标 3：确定直肠免疫是否更强。 调节失调部分解释了使用冰毒的 SMM 中 HIV 血清转化风险增加的原因。 设计中，我们将比较 HIV 血清转化者 (n=450) 与匹配的血清阴性对照 (n=450) 以检查 冰毒引起的直肠细胞因子变化与 HIV 血清转化的临床相关性。 LITE-2 计划可以通过 SMM 改变 HIV 预防来产生特殊影响。