Tailoring Healthy Relationships to Improve HIV Treatment Outcomes for MSM in Eastern Cape, South Africa

调整健康的关系以改善南非东开普省男同性恋者的艾滋病毒治疗结果

• 批准号: 10372235
• 负责人: Joseph Daniels
• 金额: $ 16.97万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-15 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10372235
• 关键词: 18 year old; AIDS prevention; Address; African; Attention; Behavioral; Caring; Cellular Phone; Clinical Trials; Communities; Couples; Diagnosis; Disclosure; Education; Evidence based intervention; Fright; Goals; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; Home; Human immunodeficiency virus test; Individual; Intervention; Knowledge; Length; Linguistics; Link; Measures; Mediator of activation protein; Names; Outcome; Outcome Measure; Participant; Partner Communications; Phase; Play; Population; Prevalence; Prevention; Qualitative Research; Randomized Controlled Trials; Research; Research Activity; Risk; Risk Assessment; Role; Safe Sex; Safety; Sampling; Self Efficacy; Sexual Partners; South Africa; South African; Stress; Testing; Time; Treatment outcome; Trust; Unsafe Sex; Videoconferencing; Viral; Viral Load result; Voice; Work; antiretroviral therapy; arm; base; behavioral adherence; condomless anal sex; cost; design; dosage; empowerment; evidence base; feasibility testing; high risk men; human centered design; improved; interest; intimate behavior; mHealth; male; men; men who have sex with men; movie; patient engagement; pilot test; pre-exposure prophylaxis; preference; programs; recruit; skills; transmission process; treatment adherence; uptake; usability; video chat; willingness

PROJECT ABSTRACT There is 18.1% HIV prevalence for men who have sex with men (MSM) in South Africa and less than 10% of HIV-positive MSM are optimally adherent to antiretroviral treatment (ART). These outcomes are consistent with findings for MSM across sub-Saharan African settings where only a quarter are virally suppressed due to suboptimal ART adherence. Further, at least one-third of new HIV infections for MSM occur within primary partnerships, driven by higher rates of condomless anal intercourse with main partners, lower levels of HIV testing among partnered men, and the desire to create trust and intimacy through condomless sex. MSM often lack skills in communicating and managing their HIV treatment and prevention with existing and new partners. Studies indicate that uptake of HIV prevention is lower within established relationships and emerging evidence indicates that inaccurate knowledge about viral suppression is reducing the impact of Undetectable = Untransmittable (U=U) strategies. To improve HIV outcomes for partnered MSM, our preliminary work identified preferences for an intervention to include smartphones with video-chat and group-based interventions focused on skill-building in HIV stress, disclosure and treatment management while in relationships. Given these findings, we identified one evidence-based intervention—Healthy Relationships (HR)—to adapt and pilot-test to assess feasibility for MSM in Eastern Cape, South Africa. This intervention improves self-efficacy in HIV disclosure risk assessment and safe sex practices. In our adaptation, we will integrate additional components of: U=U education, HIV disclosure management planning, and ART management in the home with video-conference (VC) delivery of HR, and VC check-in’s to support adherence behavioral changes. HR will be named MPowered in Relationships (MR) to reflect local voices through adaptation and the empowerment objective of intervention. In the first aim, we will adapt and assess usability of MR, integrating ADAPT-IIT phases and Human Centered Design. A community advisory board will be established to guide integration of Enhanced Components, linguistic considerations, preferences, and mHealth technical considerations for VC MR sessions and Group Check-In’s. In the second aim, we will pilot-test the feasibility of MR and its preliminary impact on behavioral and biomedical outcome measures, with a community-based sample of HIV-positive MSM who are 18 years of age or older, sub-optimally ART adherent, represent a range of relationship lengths, have HIV-negative or unknown status partner, and live in Eastern Cape. We will determine feasibility (feasibility, acceptability, willingness, safety, cost), and the preliminary impact on mediators of HIV prevention and disclosure, ART adherence, and viral load. These outcomes will inform a larger R01 clinical trial powered to measure the efficacy of MR to create gains in ART adherence for partnered MSM in South Africa, a group critically overlooked in HIV programming and research.

项目摘要 南非与男性发生性关系的男性患病率为18.1％，不到10％ HIV阳性MSM在抗逆转录病毒治疗（ART）上是最佳依从性的。这些结果与 在撒哈拉以南非洲地区的MSM的发现，由于 次优艺术依从性。此外，主要MSM至少有三分之一的新艾滋病毒感染发生 伙伴关系，由与主要伴侣的无避孕套肛交发生率较高，艾滋病毒水平较低 在合作男人之间进行测试，以及通过无避孕套的性爱来建立信任和亲密关系的愿望。 MSM经常 缺乏与现有和新合作伙伴交流和管理其艾滋病毒治疗和预防的技能。 研究表明，在已建立的关系和新兴证据中，预防HIV的吸收较低 表明关于病毒抑制的知识不准确正在减少无法检测的影响= 不可转移（U = U）策略。为了改善合作MSM的HIV结果，我们的初步工作确定了 干预措施的偏好，包括具有视频聊天和基于团体干预措施的智能手机 关于艾滋病毒压力，披露和治疗管理的技能在人际关系中。考虑到这些发现， 我们确定了一种基于证据的干预措施 - 健康关系（HR），以适应评估和试点测试 南非东开普省MSM的可行性。这种干预措施提高了艾滋病毒披露风险的自我效能感 评估和安全的性行为。在适应中，我们将集成：u = u的其他组件 视频会议的教育，艾滋病毒披露管理计划和艺术管理 （VC）交付人力资源和VC签入以支持依从性行为变化。人力资源将被命名为MPOPPOR 在关系中（MR）通过适应和授权干预的目标反映当地声音。 在第一个目标中，我们将适应和评估MR的可用性，整合适应性阶段并以人为本 设计。将建立一个社区咨询委员会，以指导增强组件的集成，语言 VC MR Sessions和Group Check-In的考虑，偏好和MHealth的技术考虑。 在第二个目标中，我们将试点MR的可行性及其对行为和生物医学的初步影响 结果指标，基于社区的艾滋病毒阳性MSM样本，年龄在18岁或以上， 次优的艺术依从物，代表一系列关系长度，具有HIV阴性或未知状态 合伙人，住在东开普省。我们将确定可行性（可行性，可接受性，意愿，安全，成本）， 以及对艾滋病毒预防和披露，艺术依从性和病毒负荷的介体的初步影响。这些 成果将为较大的R01临床试验提供通知，该试验旨在衡量MR创造艺术收益的效率 在南非的合作MSM遵守，这是一个在艾滋病毒计划和研究中被批评的小组。