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 在南非，男男性行为者 (MSM) 的艾滋病毒感染率为 18.1%，而男男性行为者 (MSM) 的感染率不到 10%。 HIV 阳性 MSM 能够最佳地坚持抗逆转录病毒治疗 (ART) 这些结果与 对撒哈拉以南非洲地区 MSM 的调查结果显示，只有四分之一的人受到病毒抑制，原因是 此外，至少三分之一的 MSM 新发 HIV 感染发生在原发性病例中。 伙伴关系，由与主要伴侣的无套肛交率较高、艾滋病毒感染率较低所推动 男性伴侣之间的测试，以及通过无套性行为建立信任和亲密关系的愿望。 缺乏与现有和新合作伙伴沟通和管理艾滋病毒治疗和预防的技能。 研究表明，在现有证据和新出现的证据中，艾滋病毒预防的采用关系较低 表明有关病毒抑制的不准确知识正在减少不可检测的影响= 为了改善合作 MSM 的艾滋病毒结果，我们的初步工作确定了。 对干预措施的偏好，包括带有视频聊天功能的智能手机和基于小组的干预措施 鉴于这些发现，关于艾滋病毒压力、披露和治疗管理的技能建设。 我们确定了一种基于证据的干预措施——健康关系（HR）——进行调整和试点测试以评估 南非东开普省 MSM 的可行性 该干预措施提高了艾滋病毒披露风险的自我效能。 在我们的调整中，我们将整合以下额外组成部分：U=U。 通过视频会议进行家庭教育、艾滋病毒披露管理规划和抗逆转录病毒治疗管理 (VC) 交付 HR 以及支持遵守行为改变的 VC 签到将被命名为 MPowered。 关系（MR），通过适应和干预的赋权目标反映当地的声音。 第一个目标是，我们将调整和评估 MR 的可用性，整合 ADAPT-IIT 阶段和以人为本 将建立一个社区咨询委员会来指导增强组件、语言的集成。 VC MR 会议和团体签到的注意事项、偏好和 mHealth 技术注意事项。 第二个目标，我们将试点测试MR的可行性及其对行为和生物医学的初步影响 结果测量，以社区为基础的 18 岁或以上 HIV 阳性 MSM 样本， 次佳 ART 依从性、代表一系列关系长度、HIV 阴性或状态未知 合作伙伴，并住在东开普省，我们将确定可行性（可行性、可接受性、意愿、安全性、成本）， 以及对艾滋病毒预防和披露、抗逆转录病毒治疗依从性和病毒载量中介因素的初步影响。 结果将为更大规模的 R01 临床试验提供信息，该试验旨在衡量 MR 的功效，从而为 ART 带来收益 南非合作 MSM 的遵守情况，这是一个在艾滋病毒规划和研究中被严重忽视的群体。