A Randomized Trial to Prevent HIV Among Gay Couples

一项预防同性恋夫妇感染艾滋病毒的随机试验

• 批准号: 9482537
• 负责人: LYNAE A DARBES
• 金额: $ 17.26万
• 依托单位: SAN FRANCISCO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-20 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9482537
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Agreement; Anal Sex; Attention; Baseline Surveys; Behavior Therapy; Cessation of life; Cost Effectiveness Analysis; Couples; Foundations; Gays; Goals; Gold; HIV; HIV Infections; HIV Seropositivity; HIV risk; Incidence; Individual; Internet; Intervention; Investments; Knowledge; Longitudinal Studies; Mediating; Mediation; Mediator of activation protein; Modeling; Persons; Population; Prevention; Preventive Intervention; Process; Randomized; Randomized Controlled Trials; Research; Risk Factors; Risk Reduction; Science; Social support; Surveys; Testing; Time; Viral Load result; base; cost effective; cost effectiveness; efficacy testing; epidemiology study; follow-up; high risk; high risk population; male; men; men who have sex with men; pre-exposure prophylaxis; prevent; programs; randomized trial; satisfaction; scale up; sex; sex risk; skills; theories; trend

In the US, men who have sex with men (MSM) represent the largest proportion of AIDS deaths, people living with AIDS, and HIV incidence. While numerous prevention efforts targeting MSM have successfully reduced HIV incidence in the US, many men are not reached, including gay couples. Several epidemiological studies attribute high rates of new HIV infections to condomless anal sex within male primary partnerships, but few prevention interventions are available to address and reverse this trend. Several factors have recently changed the HIV prevention landscape, including advancements in biomedical strategies, an increased desire to develop interventions that can be scaled up efficiently and a need to develop cost-effective programing due to decreases in prevention dollars. Multi-session individual- and group-level in-person sexual risk reduction interventions for MSM were the gold standard for many years. Behavioral interventions have also been delivered via the internet, since they are convenient, able to reach large numbers of individuals and less labor intensive to implement, compared to interventions delivered via multiple in- person sessions. It is important to examine the optimal modes of providing prevention interventions in the context of this changing prevention landscape. The majority of prevention interventions targeting MSM are individual-focused. However, over the years, our research has identified unique prevention needs for gay couples that have not been sufficiently addressed in individual-focused interventions. For example, while most gay couples have agreements about sex with partners outside the relationship, many couples have difficulty negotiating their agreements, some have difficulty adhering to their agreements and those who break their agreements have difficulty disclosing the break to their partner; all of which could pose potential HIV risk for the couple. Our study team has led the field in examining relationship dynamics among gay couples. With a goal to develop a theory driven yet empirically-informed intervention, we have been studying the nuances of relationships and determining the HIV risk factors that either persist or change over time. Several years of longitudinal quantitative and qualitative studies, have yielded the evidence for an empirically- driven model that provides a foundational framework for the proposed intervention. Additionally, due to a dearth of prevention interventions for gay couples, there is little documented knowledge about the best modes of intervention delivery. Specifically, we do not know if it is efficacious for couples to participate in an intervention in-person or online. We also do not know if particular topics are best addressed using one of these modes or the other. To address these questions, we propose in an R01 application, to test the efficacy of our theory-based and empirically-driven HIV risk reduction intervention for gay male couples using a randomized controlled trial.

在美国，男男性行为者（MSM）在艾滋病死亡人数中所占比例最大， 艾滋病患者和艾滋病毒发病率。尽管针对 MSM 的预防工作很多 已成功降低美国的艾滋病毒发病率，但许多男性尚未达到，包括同性恋 情侣。多项流行病学研究将新发艾滋病毒感染率高归因于 男性主要伴侣中存在无套肛交，但很少有预防干预措施 可以解决并扭转这一趋势。 最近有几个因素改变了艾滋病毒预防格局，其中包括进展 在生物医学策略中，人们越来越渴望开发可扩大规模的干预措施 由于预防工作的减少，需要制定具有成本效益的规划 美元。多场个人和团体层面的面对面性风险降低干预措施 多年来，MSM 一直是黄金标准。行为干预也已 通过互联网提供，因为它们很方便，能够覆盖大量个人 与通过多种途径提供的干预措施相比，实施起来的劳动密集度较低 人会议。重要的是研究提供预防的最佳模式 在这种不断变化的预防形势下采取干预措施。 大多数针对 MSM 的预防干预措施都是以个人为中心的。然而，超过 多年来，我们的研究已经确定了同性恋伴侣的独特预防需求，而这些需求尚未 在以个人为中心的干预措施中得到了充分解决。例如，虽然大多数同性恋 夫妻与关系之外的伴侣就性行为达成了协议，许多夫妇都有 谈判协议时遇到困难，有些人难以遵守协议， 那些违反协议的人很难向他们的伴侣透露违反协议的情况；所有的 这可能会给这对夫妇带来潜在的艾滋病毒风险。我们的研究团队在检查方面处于领先地位 同性恋伴侣之间的关系动态。以开发理论驱动的目标为目标 基于经验的干预，我们一直在研究关系和 确定持续存在或随时间变化的艾滋病毒危险因素。数年的 纵向定量和定性研究，已经为实证提供了证据 驱动模型为拟议的干预措施提供了基础框架。此外， 由于缺乏针对同性恋伴侣的预防干预措施，记录的知识很少 关于干预实施的最佳模式。具体来说，我们不知道它是否有效 夫妻亲自或在线参与干预。我们也不知道是否有特殊情况 最好使用这些模式中的一种或另一种来解决主题。为了解决这些问题， 我们在 R01 应用程序中建议，测试我们基于理论和经验驱动的有效性 使用随机对照试验对男同性恋夫妇进行艾滋病毒风险降低干预。