PrEP for HIV Prevention in MSM: Mixed-Methods Study of Behavior & Message Framing

MSM 中 HIV 预防的 PrEP：行为的混合方法研究

• 批准号: 8474843
• 负责人: Kristen Underhill
• 金额: $ 17.48万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8474843
• 关键词: AIDS prevention; Address; Adherence; Anti-Retroviral Agents; Area; Attitude; Award; Behavior; Behavior Therapy; Behavioral; Belief; Centers for Disease Control and Prevention (U.S.); Cognitive; Data; Development; Disinhibition; Dose; Drug Formulations; Effectiveness; Evaluation; Failure; Financial compensation; Focus Groups; Future; Goals; HIV; HIV Infections; HIV risk; Health Communication; Incidence; Individual; Infection; Intervention; Interview; Knowledge; Link; Male Circumcision; Marketing; Measures; Mentors; Methods; Modeling; Oral; Outcome; Outcome Measure; Participant; Patient Self-Report; Perception; Pharmaceutical Preparations; Phase; Population; Preparation; Prevention strategy; Process; Prophylactic treatment; Psychosocial Factor; Public Health; Qualitative Research; Randomized Controlled Trials; Reporting; Research; Research Training; Risk; Risk Behaviors; Safety; Sampling; Schedule; Science; Site; Source; Tenofovir; Testing; Training; Uncertainty; Unsafe Sex; Vaccines; Work; aged; base; behavior influence; career; contextual factors; design; efficacy trial; emtricitabine; expectation; experience; high risk; innovation; male; men; men who have sex with men; microbicide; prevent; programs; public health relevance; randomized trial; scale up; skills; success; theories; therapy development; willingness

DESCRIPTION (provided by applicant): This K01 research and training award advances the long-term goal of integrating behavioral and biomedical strategies for preventing HIV among men who have sex with men (MSM). The proposed training will enable the PI to develop the skills needed for an independent research career in this field. The research plan focuses on the behavioral impacts of antiretroviral pre-exposure prophylaxis (PrEP), an emerging biomedical strategy for HIV prevention. PrEP is anticipated to be partially efficacious for preventing new infections, and models based on early study data suggest that PrEP may reduce HIV incidence among MSM. However, PrEP's actual effectiveness will depend on users' behaviors, and uncertainty about these behaviors hampers efforts to plan for scale-up. We focus on two behaviors: PrEP initiation - starting to use PrEP; and risk compensation - the possibility that users will take more HIV-related risks on the belief that they are protected from infection. Exploratory research suggests that expectations of PrEP efficacy will influence each behavior, but we lack conceptual models of either behavior among MSM. There is also concern about how these behaviors might be influenced by different strategies for describing PrEP's efficacy. We address these gaps, focusing on MSM in Providence, RI. Phase 1 will use focus groups and individual qualitative interviews to explore psychosocial and contextual factors likely to influence PrEP initiation and risk compensation. Phase 2 will draw on these findings and prior work in biomedical HIV prevention to develop a conceptual model of each behavior, and quantitative outcomes assessing willingness to use PrEP, attitudes about risk compensation, and expectations of PrEP's efficacy. Phase 3 will rely on message framing principles to conduct a randomized trial of two strategies for communicating with MSM about PrEP, one using success-based messages (emphasizing PrEP's likelihood of preventing HIV), and one using failure-based messages (using identical estimates of efficacy, but emphasizing PrEP's likelihood of failure). We hypothesize that participants receiving success-based messages will be more willing to use PrEP, but will have higher expectations of efficacy and more permissive attitudes toward risk compensation. Our findings may generalize to other partially efficacious HIV prevention strategies, such as vaccines and circumcision. Future research plans include developing behavioral interventions to optimize PrEP use among MSM. To enable the PI to pursue this long-term research agenda, she will work with experienced mentors to build four areas of expertise: (1) expertise in the behavioral impacts of biomedical HIV prevention, including links among PrEP, post-exposure prophylaxis, vaccines, microbicides, and circumcision; (2) expertise in health communications and message framing; (3) skills for conducting qualitative research in mixed-methods studies; and (4) skills for conducting quantitative research in mixed-methods studies, including developing outcome measures, implementing trials, and statistically analyzing trial data. This K01 addresses a key priority in HIV prevention science, and it will fully prepare the PI for an independent research career in the field.

描述（由申请人提供）：该 K01 研究和培训奖项推进了整合行为和生物医学策略以预防男男性行为者 (MSM) 感染艾滋病毒的长期目标。拟议的培训将使 PI 能够培养该领域独立研究职业所需的技能。该研究计划的重点是抗逆转录病毒暴露前预防（PrEP）的行为影响，这是一种新兴的艾滋病毒预防生物医学策略。 PrEP 预计对预防新感染有部分效果，基于早期研究数据的模型表明 PrEP 可能会降低 MSM 中的 HIV 发病率。然而，PrEP 的实际有效性将取决于用户的行为，而这些行为的不确定性阻碍了扩大规模的计划。我们关注两种行为： PrEP 启动 - 开始使用 PrEP；和风险补偿——用户相信自己不会受到感染而承担更多与艾滋病毒相关的风险的可能性。探索性研究表明，对 PrEP 功效的期望会影响每种行为，但我们缺乏 MSM 中任一行为的概念模型。人们还担心这些行为可能会受到描述 PrEP 功效的不同策略的影响。我们致力于解决这些差距，重点关注罗德岛州普罗维登斯的 MSM。第一阶段将利用焦点小组和个人定性访谈来探索可能影响 PrEP 启动和风险补偿的社会心理和背景因素。第二阶段将利用这些发现和艾滋病毒生物医学预防方面的先前工作，开发每种行为的概念模型，以及评估使用 PrEP 的意愿、对风险补偿的态度以及对 PrEP 功效的期望的定量结果。第三阶段将依靠消息框架原则对两种与 MSM 沟通 PrEP 的策略进行随机试验，一种使用基于成功的消息（强调 PrEP 预防 HIV 的可能性），另一种使用基于失败的消息（使用相同的估计值）功效，但强调 PrEP 失败的可能性）。我们假设，收到基于成功的信息的参与者将更愿意使用 PrEP，但对疗效有更高的期望，对风险补偿也持更宽容的态度。我们的研究结果可能推广到其他部分有效的艾滋病毒预防策略，例如疫苗和包皮环切术。未来的研究计划包括开发行为干预措施以优化 MSM 中 PrEP 的使用。为了使 PI 能够实现这一长期研究议程，她将与经验丰富的导师合作，建立四个专业领域：（1）生物医学 HIV 预防的行为影响方面的专业知识，包括 PrEP、暴露后预防、疫苗之间的联系、杀菌剂和包皮环切术； (2) 健康传播和信息框架方面的专业知识； (3) 在混合方法研究中进行定性研究的技能； (4) 在混合方法研究中进行定量研究的技能，包括制定结果指标、实施试验和统计分析试验数据。 K01 解决了艾滋病毒预防科学的一个关键优先事项，它将为 PI 在此领域的独立研究生涯做好充分准备。