Acceptability, feasibility, and preliminary impact of a web-based, HIV prevention toolkit with cisgender male couples in Lima, Peru

秘鲁利马顺性别男性夫妇基于网络的艾滋病毒预防工具包的可接受性、可行性和初步影响

• 批准号: 10633222
• 负责人: Jason W Mitchell
• 金额: $ 19.94万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10633222
• 关键词: AIDS prevention; Adherence; Agreement; Algorithms; Area; Cellular Phone; Communication; Computers; Consent; Couples; Data Sources; Devices; Electronics; Elements; Eligibility Determination; Enrollment; Evaluation; Feedback; Goals; HIV; HIV Seronegativity; HIV Seropositivity; HIV/STD; Health; Home; Incidence; Individual; Internet; Intervention; Interview; Location; Measurement; Methods; Modeling; Online Systems; Outcome; Pattern; Peru; Pilot Projects; Prevention; Prevention strategy; Public Health; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Research; Risk; Risk Reduction; STI prevention; Sex Behavior; Sexual Health; Stratification; Surveys; Testing; Time; Treatment Efficacy; United States Public Health Service; Update; Waiting Lists; Work; antiretroviral therapy; arm; behavior change; behavior test; cisgender; clinical care; commune; condoms; coping; cost; eHealth; evidence base; experience; follow-up; human centered design; improved; interest; male couples; member; men; men who have sex with men; novel; pre-exposure prophylaxis; preference; prevent; prevention service; preventive intervention; response; sexual minority men; sexual risk behavior; theories; transmission process; treatment as prevention; uptake; usability; web platform

1 SUMMARY / ABSTRACT 2 3 Sexual minority men in Lima, Peru are disproportionately impacted by HIV, and a substantial proportion of these 4 men acquire HIV while in a relationship (i.e., cisgender male couples). Studies conducted by members of the 5 investigative team found that cisgender male couples’ use of evidence-based HIV/STI prevention strategies (e.g., 6 ART, PrEP, routine HIV/STI testing, condom use) are sub-optimal to reliably prevent acquisition and/or 7 transmission of HIV and other STIs given their current engagement in sexual risk behaviors. To date, no couples- 8 based HIV/STI prevention interventions are available in Lima or elsewhere in Peru. The overarching goal of the 9 proposed 3-year project is to help fill this critical gap in Peru’s HIV/STI prevention services. To start, we 10 conducted a mixed method pilot project to assess the acceptability of the PI’s theoretically-grounded eHealth, 11 couples-based HIV/STI prevention toolkit intervention with 42 cisgender male couples in Lima (14 concordant 12 HIV-negative, 16 discordant, 12 concordant HIV-positive). 90% of couples reported high acceptability of the 13 intervention, and liked the agreement builder activity the most. Couples told us they wanted more information 14 about HIV treatment as prevention (PrEP, ART, TasP/U=U) and how to strengthen and manage their own and 15 familial relationships (cultural context). They also wanted the intervention to be accessible on different web- 16 connected devices. Additional findings revealed only 33%-50% of couples included evidence-based HIV/STI 17 prevention strategies in their agreement. To help improve couples’ uptake and continued use of evidence-based 18 prevention strategies, our solution is to integrate an electronic algorithm into the agreement builder activity to 19 provide them with tailored recommendations that align with their engagement in sexual behaviors and 20 relationship profile. Methods: Via the proposed R34, our next steps are to apply the remaining stages of the 21 ADAPT-ITT model with elements of human-centered design to adapt our couples-based intervention. We will 22 then conduct a 6-month pilot RCT with a waitlist control to assess the feasibility, acceptability, and preliminary 23 impact of the adapted intervention with 60 cisgender male couples, stratified by their dyad HIV serostatus, on 24 outcomes of: a) formation and adherence to a tailored risk-reduction plan and agreement; b) relationship 25 functioning (e.g., communication); c) use of evidence-based HIV prevention strategies; and d) HIV/STI incidence 26 over time. Our proposed approach is rigorous with scientific premise as mixed methods and a pilot RCT with 27 a waitlist control will be used to achieve our Specific Aims. Our project is also timely and practical with key 28 stakeholder buy-in, suggesting the high Public Health significance of our proposal. Our findings will reveal the 29 feasibility, acceptability and preliminary impact of the adapted toolkit intervention to reduce couples’ HIV/STI risk 30 via sustained use of evidence-based HIV prevention strategies over time through their formation and adherence 31 to a tailored agreement and risk-reduction plan. Our next step will be to apply these findings (e.g., R01) to test 32 the intervention for efficacy. Our project is of interest to NOT-MH-20-019 and NOT-MH-20-020.

1摘要 /摘要 2 秘鲁利马的3性少数族裔男性受艾滋病毒的影响不成比例，其中很大一部分 有4人在恋爱关系中获得艾滋病毒（即，是男性男性夫妇）。由成员进行的研究 5调查小组发现，男性夫妇使用基于证据的HIV/STI预防策略（例如， 6艺术，准备，常规的HIV/STI测试，使用避孕套）是最佳的，可以可靠地防止获取和/或 7鉴于他们目前从事性风险行为的参与，艾滋病毒和其他性传播感染的传播。迄今为止，没有夫妻 - 利马或秘鲁其他地方可提供8种基于HIV/STI的预防干预措施。总体目标 9建议的3年项目旨在帮助填补秘鲁的HIV/STI预防服务中的这一关键空白。首先，我们 10进行了一个混合方法试验项目，以评估PI理论基础的eHealth的可接受性， 11对夫妇的艾滋病毒/STI预防工具包干预与42位男同性恋夫妇在利马（14个一致） 12 HIV阴性，16不同意，12一致）。 90％的夫妇报告说 13干预措施，最喜欢协议建设者活动。夫妻告诉我们，他们想要更多信息 14关于艾滋病毒治疗作为预防（准备，艺术，tasp/u = u），以及如何加强和管理自己的 15家庭关系（文化背景）。他们还希望在不同的网络上可以访问干预措施 - 16个连接的设备。其他发现显示，只有33％-50％的夫妇包括基于证据的HIV/STI 17预防策略达成协议。帮助改善夫妻的吸收并继续使用循证 18预防策略，我们的解决方案是将电子算法集成到协议构建器活动中 19向他们提供量身定制的建议，这些建议与他们从事性行为的参与和 20关系概况。方法：通过拟议的R34，我们的下一步是应用其剩余阶段 21 Adapt-Itt模型具有以人为本设计的元素，以适应我们的基于夫妇的干预措施。我们将 22然后进行6个月的飞行员RCT，并具有候补名单控制，以评估可行性，可接受性和初步 23对60种cisgender雄性夫妇的改编干预的影响，由其二元艾滋病毒血清分层 24结局：a）形成和遵守量身定制的降低风险计划和协议； b）关系 25功能（例如，通信）； c）使用基于证据的艾滋病毒预防策略；和d）艾滋病毒/STI事件 26随着时间的流逝。我们提出的方法是严格的，科学信念是混合方法，而试点RCT与 27将使用等待名单控制来实现我们的特定目标。我们的项目也及时且实用 28利益相关者的买入，这表明我们的提案具有很高的公共卫生意义。我们的发现将揭示 29改编工具包干预措施的可行性，可接受性和初步影响，以降低夫妻的HIV/STI风险 30通过持续使用基于证据的艾滋病毒预防策略，随着时间的流逝而通过其形成和遵守 31量身定制的协议和降低风险计划。我们的下一步是将这些发现（例如R01）应用于测试 32干预效率。我们的项目对NOT-MH-20-019和NOT-MH-20-020感兴趣。