Unified Approach to Address PrEP Cascade for BMSM

解决 BMSM PrEP 级联问题的统一方法

• 批准号: 9751972
• 负责人: Lisa A Eaton
• 金额: $ 28.15万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751972
• 关键词: AIDS prevention; Address; Adherence; Area; Awareness; Behavior Therapy; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Cognition; Cognitive; Collaborations; Communities; Costs and Benefits; Counseling; Diagnosis; Educational workshop; Epidemic; Feedback; Focus Groups; Funding; Goals; Guidelines; HIV; HIV Infections; Incidence; Individual; Intervention; Interview; Modeling; Motivation; Outcome; Pharmaceutical Preparations; Population; Prevalence; Prevention; Prevention approach; Procedures; Request for Applications; Research; Research Methodology; Resources; Risk; Risk Reduction; Series; Site; Structure; Testing; Text Messaging; Treatment Efficacy; Work; antiretroviral therapy; base; black men who have sex with men; community based participatory research; design; experience; health care availability; high risk; improved; interest; novel; pre-exposure prophylaxis; prevent; randomized trial; research and development; role model; service delivery; service providers; social; social stigma; stem; theories; therapy development; tool; transmission process; uptake

Biomedical HIV prevention tools are very promising, but are not sufficiently reaching those in greatest need. This R34 application requests support to develop a novel, unified model to address PrEP interest, uptake, and adherence among Black men who have sex with men (BMSM). BMSM have experienced elevated rates of HIV incidence and prevalence since the beginning of the US epidemic, and the CDC estimates that half of BMSM will be diagnosed with HIV in their lifetime. In our current (non-overlapping) work, we have documented an exceedingly high 5.1% annual HIV incidence rate and 35% HIV prevalence rate among BMSM (R01MH094230, N=549). Although Pre-Exposure Prophylaxis (PrEP) is highly effective for preventing HIV, there is urgent need to improve efforts to deliver PrEP, in particular, for BMSM at-risk for HIV. Current strategies to increase PrEP interest, uptake, and adherence are not adequate and there are formidable barriers (e.g., stigma surrounding PrEP use, and adherence and retention concerns) to sufficient coverage of PrEP that must be addressed. Without considerable and targeted change to our current approach to PrEP delivery, we will fail to adequately provide PrEP to those in greatest need. In our PrEP focused preliminary studies with BMSM, we have identified two primary areas in need of critical focus and intervention – (1) stigma related to PrEP use, and (2) medication cognitions such as the perceived costs and benefits of taking PrEP, both of which can impede PrEP interest, uptake, and adherence. To address these areas we are proposing to develop an intervention model grounded in two novel cognitive/behavioral theories: the HIV Stigma Framework and the Medication Necessity-Concerns Framework. Our proposed study includes: Specific Aim 1: Conduct elicitation research with BMSM, community advisers, and expert consultants to design an empirically-based PrEP enhancement intervention for use in targeted service delivery settings. Specific Aim 2: PrEP messaging and intervention content will be assessed by a community advisory panel, and intervention feasibility and acceptability will be completed by conducting a pre-pilot test of the intervention procedures. Specific Aim 3: Conduct a pilot test that compares the PrEP enhancement intervention (N=100), including on-demand interactive text messaging, to a contact matched PrEP information only and sexual risk counseling control intervention (N=50) at 2, 4, and 6 month follow-ups on PrEP uptake, adherence, and persistence in order to establish preliminary intervention efficacy. Advances in biomedical HIV prevention, such as the availability of PrEP, will only impact the HIV epidemic if concurrent efforts are made to address the social and behavioral challenges that are associated with achieving sufficient coverage of PrEP among individuals at elevated risk for HIV. Low-resource burden, easily implemented, and effective social/behavioral interventions are urgently needed if the full benefits of PrEP are to be realized. If effective and disseminated, this intervention would meet current prevention needs and its potential impact on HIV infections averted could be substantial.

非常承诺，生物医学艾滋病毒预防工具，但还不足以满足最需要的人。这 R34应用程序请求支持开发一种小说，统一的模型，以解决Prep有趣，吸收和 与男人发生性关系（BMSM）的黑人遵守。 BMSM的艾滋病毒率升高 自美国开始以来的发病率和流行率，CDC估计BMSM的一半将 被诊断出艾滋病毒一生。在我们当前的（非重叠）工作中，我们记录了一个 BMSM中极高的5.1％年HIV事件率和35％的HIV患病率（R01MH094230， N = 549）。 改善BMSM高危艾滋病毒的准备的努力。当前增加准备的策略 兴趣，吸收和依从性不足，并且存在强大的障碍（例如，周围的污名化 准备使用，依从性和保留问题），以充分解决必须解决的准备工作。 没有对我们当前的准备交付方法进行大量和针对性的更改，我们将无法充分 为最需要的人提供准备。在我们通过BMSM进行准备的初步研究中，我们已经确定了 需要关键重点和干预的两个主要领域 - （1）与PrEP使用相关的污名和（2）药物 认知，例如感知到的成本和收益，这两者都会阻碍准备兴趣， 吸收和坚持。为了解决这些领域，我们建议开发以基于 两个新型的认知/行为理论：HIV污名框架和药物必需品 框架。我们提出的研究包括：特定目的1：与BMSM，社区进行启发研究 顾问和专家顾问，设计基于经验的PREP增强干预措施 有针对性的服务交付设置。特定目标2：将评估准备消息传递和干预内容 由社区咨询小组以及干预可行性和可接受性将通过进行 干预程序的前练习测试。特定目标3：进行试验测试，比较准备 增强干预措施（n = 100），包括按需交互式文本消息，与触点匹配的准备 仅在2、4和6个月的随访中，仅信息和性风险咨询控制干预措施（n = 50） 为了建立初步干预效率，吸收，依从性和持久性。 生物医学艾滋病毒预防的进步，例如PREP的可用性，只会影响艾滋病毒 流行病是否同时努力应对与之相关的社会和行为挑战 在艾滋病毒风险较高的个体中实现足够的准备范围。低源伯恩伯恩很容易 如果准备的全部好处是 实现。如果有效和传播，这种干预将满足当前的预防需求及其潜力 避免对艾滋病毒感染的影响可能很大。