Expedited Partner Therapy and STI Control for MSM in Peru

秘鲁 MSM 的快速伴侣治疗和性传播感染控制

• 批准号: 8153915
• 负责人: Thomas J. Coates
• 金额: $ 17.91万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8153915
• 关键词: Address; Anatomic Sites; Antibiotic Therapy; Behavior Therapy; Behavioral; California; Centers for Disease Control and Prevention (U.S.); Chlamydia; Chlamydia Infections; Clinical Trials; Clinical effectiveness; Coitus; Complex; Counseling; Coupling; Data; Decision Making; Development; Diagnosis; Dimensions; Environment; Epidemic; Epidemiology; Europe; Evaluation; Focus Groups; Foundations; Future; Gender; Gonorrhea; Guidelines; HIV; HIV Infections; HIV/STD; Heterosexuals; Incidence; Individual; Infection; Interdisciplinary Study; Intervention; Interview; Low Prevalence; Methods; Nature; Network-based; Notification; Outcome; Outcome Measure; Participant; Partner Notification; Patients; Pattern; Peru; Pilot Projects; Population; Population Study; Practice Management; Prevalence; Preventive Intervention; Process; Protocols documentation; Randomized; Randomized Clinical Trials; Recommendation; Recurrence; Reporting; Risk Factors; Series; Sexual Partners; Social Environment; Structure; Syphilis; Theoretical model; Therapeutic Intervention; Urethra; Visit; burden of illness; design; evidence base; experience; follow-up; genital herpes; instrument; male; men; men who have sex with men; rectal; research study; social; transmission process

DESCRIPTION (provided by applicant): Expedited Partner Therapy (EPT) has been shown to reduce rates of persistent or recurrent gonorrhea and chlamydia infection in heterosexual patients, but has not been evaluated for use among men who have sex with men (MSM). CDC guidelines support the use of EPT for partner management with heterosexual patients, but note the absence of evidence necessary to make an equivalent recommendation for the use of EPT with MSM. Randomized clinical trials to assess the impact of EPT on partner notification, treatment, and STI re- infection among MSM are critical to the development of evidence-based partner management guidelines. Our recent data from urban Peru has identified prevalences of rectal and pharyngeal gonorrhea and chlamydia ranging from 5-20%. The elevated burden of disease among MSM in Peru suggests that frequent transmission of undiagnosed gonorrhea and chlamydia through MSM sexual networks may be a factor contributing to the persistently high incidence of HIV infection among MSM in the region. We propose a pilot evaluation of the effect of EPT on partner notification and treatment among MSM in Peru diagnosed with gonorrhea or chlamydia at any anatomic site. Specific Aim 1: To explore the social norms and structural factors influencing partner notification and treatment among MSM in Peru. Specific Aim 2: To determine the effect of EPT on anticipated and actual partner notification among MSM diagnosed with gonorrhea or chlamydia infection. Specific Aim 3: To develop preliminary data on rates of gonococcal and chlamydial re-infection among MSM randomized to receive EPT compared with standard partner notification counseling. As a theoretical model, EPT integrates behavioral, social, and biomedical approaches to HIV/STI control in a comprehensive prevention intervention. Our proposed exploration of the social and behavioral dimensions of partner notification and treatment will provide a methodological structure for understanding the influence of EPT on behavioral decision-making processes, interpersonal factors that influence partner notification, and network patterns of STI transmission within MSM populations in Peru. Our biomedical assessment of gonorrhea and chlamydia re-infection will provide preliminary data to support the development of a definitive clinical trial of EPT for HIV/STI control in MSM populations. Practical issues including an evaluation of methods to assess notification and treatment rates, determination of the composition of participants' sexual networks (including the number of unlocatable partners in participant networks), and an overview of logistical issues involved in implementing and assessing an EPT intervention in the local environment, will all contribute to the development and refinement of a future trial of EPT for HIV/STI control with MSM. PUBLIC HEALTH RELEVANCE: STI co-infection is an important risk factor for HIV transmission during sexual intercourse, particularly among men who have sex with men (MSM). Expedited Partner Therapy (EPT) has been shown to be effective in controlling the spread of STIs in heterosexual partnerships, but has not been evaluated among MSM. We propose a pilot study of the impact of EPT on partner notification and treatment among MSM in Peru diagnosed with gonorrhea or chlamydia.

描述（由申请人提供）：已证明加急伴侣治疗（EPT）可降低异性恋患者的持续性或复发性淋病和衣原体感染的率，但尚未评估与男性发生性关系的男性（MSM）中使用。 CDC指南支持与异性恋患者一起将EPT用于合作伙伴管理，但请注意，缺乏对与MSM一起使用EPT的同等建议所需的证据。随机临床试验，以评估EPT对MSM之间的伴侣通知，治疗和感染的影响对于制定基于证据的伙伴管理指南至关重要。 我们最近来自秘鲁城市的数据确定了直肠和咽淋病和衣原体的患病率，范围从5-20％。秘鲁MSM中疾病负担的增加表明，通过MSM性网络频繁传播未诊断的淋病和衣原体可能是导致该地区MSM中HIV感染持续高的因素。我们提出了对EPT对在任何解剖部位被诊断为淋病或衣原体诊断为伴侣通知和治疗的影响的试点评估。具体目的1：探索秘鲁MSM中伴侣通知和治疗的社会规范和结构性因素。具体目的2：确定EPT对被诊断为淋病或衣原体感染的MSM预期和实际伴侣通知的影响。具体目的3：与标准合作伙伴通知咨询相比，MSM随机接收EPT的淋球菌和衣原体再感染率的初步数据。 作为一种理论模型，EPT将行为，社会和生物医学方法整合在全面的预防干预中。我们对伴侣通知和治疗的社会和行为维度的拟议探索将为理解EPT对行为决策过程的影响提供一种方法论结构，这是我们秘鲁MSM种群中STI传播的网络传播的人际交往因素。我们对淋病和衣原体再感染的生物医学评估将提供初步数据，以支持开发EPT对MSM种群中HIV/STI控制的确定临床试验。实际问题包括评估通知和治疗率的方法，确定参与者性网络的组成（包括参与者网络中的非社交伙伴的数量），以及对实施和评估当地环境实施和评估EPT干预涉及的后勤问题的概述，都将对EPT对EPT的发展和改进HIV/STSI的改进，并将 公共卫生相关性：STI共同感染是性交期间艾滋病毒传播的重要危险因素，尤其是在与男性发生性关系的男性中。加急伴侣治疗（EPT）已被证明可以有效控制性传播感染在异性恋伙伴关系中的传播，但尚未在MSM之间进行评估。我们提出了一项试点研究，该研究对EPT对被诊断为淋病或衣原体的秘鲁MSM的伴侣通知和治疗的影响。