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）：这项K01研究和培训奖提出了整合行为和生物医学策略，以预防与男性发生性关系的男性（MSM）的艾滋病毒。拟议的培训将使PI能够发展该领域独立研究生涯所需的技能。该研究计划着重于抗逆转录病毒前预防的行为影响（PREP），这是一种新兴的HIV预防生物医学策略。预计PREP可以部分有效预防新的感染，并且基于早期研究数据的模型表明，PREP可能会降低MSM之间的HIV发病率。但是，PREP的实际有效性将取决于用户的行为，并且这些行为的不确定性阻碍了计划扩展的努力。我们专注于两种行为：准备启动 - 开始使用准备；和风险补偿 - 用户认为他们受到保护免受感染的信念，用户可能会承担更多与HIV相关的风险。探索性研究表明，对准备效力的期望将影响每种行为，但是我们缺乏MSM中任何一种行为的概念模型。还担心这些行为如何受到描述Prep功效的不同策略的影响。我们解决了这些差距，重点是RI普罗维登斯的MSM。第1阶段将使用焦点小组和个人定性访谈来探索可能影响准备启动和风险补偿的社会心理和上下文因素。第2阶段将利用这些发现和预防生物医学艾滋病毒的先前工作，以开发每种行为的概念模型，并评估使用PREP的意愿，对风险补偿的态度以及对PREP效力的期望的定量结果。第三阶段将依靠消息框架原则来进行两种与MSM沟通有关PREP的策略的随机试验，其中一项使用基于成功的消息（强调PREP的预防HIV的可能性），另一项使用基于失败的消息（使用基于失败的消息（使用相同的功效估计），但强调Prep Prep的失败可能性）。我们假设接收基于成功的消息的参与者将更愿意使用PREP，但对疗效和对风险补偿的宽容态度的期望更高。我们的发现可能会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制定行为干预措施，以优化MSM中的PREP使用。为了使PI能够追求这一长期研究议程，她将与经验丰富的导师合作，建立四个专业知识：（1）生物医学艾滋病毒预防的行为影响方面的专业知识，包括PREP，预防后预防，疫苗，疫苗，微生物和包皮环切术之间的联系； （2）健康通信和消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。该K01介绍了艾滋病毒预防科学的关键优先事项，它将为该领域的独立研究生涯做好准备。