Enhancing HIV prevention and reducing alcohol use among people receiving STI care in Malawi: An HIV status neutral approach

在马拉维接受性传播感染护理的人群中加强艾滋病毒预防并减少饮酒：艾滋病毒状况中立的方法

• 批准号: 10696585
• 负责人: Kathryn Elizabeth Lancaster
• 金额: $ 22.02万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10696585
• 关键词: AIDS prevention; Adherence; Adult; Africa South of the Sahara; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohols; Behavior Therapy; Behavioral; Biological Markers; Caring; Clinic; Cognitive; Counseling; Elements; Enrollment; Environment; Evidence based intervention; Failure; Goals; HIV; HIV Seronegativity; Heavy Drinking; Human immunodeficiency virus test; Incidence; Infection; Intervention; Interview; Malawi; Manuals; Methods; Modeling; Motivation; Multiple Partners; Newly Diagnosed; Outcome; Participant; Pathway interactions; Persons; Policy Maker; Population Heterogeneity; Population Intervention; Populations at Risk; Prevalence; Prevention program; Problem Solving; Professional counselor; Provider; Public Health; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Infrastructure; Resource-limited setting; Risk; Sexually Transmitted Diseases; Site; Structure; Testing; Treatment Effectiveness; Treatment outcome; Unsafe Sex; Viral; Virus Shedding; Woman; Work; alcohol abuse therapy; alcohol intervention; alcohol prevention; alcohol use disorder; antiretroviral therapy; arm; co-infection; effectiveness study; effectiveness/implementation trial; flexibility; hazardous drinking; high risk; high risk population; implementation measures; implementation study; improved; innovation; intervention participants; men; motivational enhancement therapy; phosphatidylethanol; pre-exposure prophylaxis; prevention effectiveness; programs; reduced alcohol use; responders and non-responders; skills; success; transmission process; treatment as usual; treatment optimization; treatment program; trial comparing; uptake

PROJECT SUMMARY HIV continues to be a significant public health problem throughout sub-Saharan Africa, including in Malawi. Sexually transmitted infection (STI) care settings are underutilized venues to simultaneously reach virally unsuppressed people with HIV (PWH) and those at high risk of HIV and have the potential to optimize HIV prevention and treatment outcomes. Hazardous alcohol use is widespread in Malawi and among people receiving STI care and is a critical barrier to the success of HIV prevention efforts. TrEAT is a brief, highly effective, culturally appropriate, scalable, evidence-based intervention (EBI) for alcohol reduction. While culturally appropriate for diverse settings, TrEAT has not been adapted for the shifting HIV care environment that includes both PWH and people at high risk for HIV. Through preliminary work, our team has demonstrated that: 1) Hazardous alcohol use is highly prevalent among people receiving STI care in SSA, including Malawi; 2) TrEAT is culturally appropriate, feasibile, acceptable, and effective at reducing alcohol use and improving viral suppression among PWH across global settings, including in SSA; and 3) Successfully led alcohol reduction and HIV prevention and treatment effectiveness and implementation studies. The overall goal for this R34 application is to produce a culturally adapted, scalable HIV ‘status-neutral’ EBI for alcohol reduction and HIV prevention and treatment optimization to test in an R01 hybrid effectiveness-implementation trial. We will conduct a 2-arm pilot randomized controlled trial (RCT) comparing TrEAT4All to usual care to assess the preliminary efficacy and implementation of HIV prevention and treatment within one STI care setting which serves as an early Pre-exposure Prophylaxis (PrEP) implementation site in Lilongwe, Malawi. Drawing from our previous manualized interventions, we will develop a 3-session intervention, TrEAT4All, that integrates HIV prevention and treatment counseling into TrEAT to improve HIV prevention outcomes—PrEP use for those who are at risk for HIV and viral suppression for PWH. Our specific aims are to 1) Adapt TrEAT, an EBI for alcohol reduction, to integrate HIV status-neutral counseling (TrEAT4All) for PWH and those at high risk of HIV who report heavy drinking and are receiving STI care in Malawi; 2) Evaluate short-term efficacy and implementation of TrEAT4All for optimizing HIV prevention and treatment outcomes (viral suppression among PWH; PrEP use among those at high risk of HIV) and proportion of heavy drinking days in past 30 days; and 3) Explore pathways of TrEAT4All responsiveness among intervention participants. Results will have relevance for integrating alcohol reduction EBIs into real-world STI care settings to optimize HIV prevention and treatment programs throughout sub-Saharan Africa and other regions where alcohol plays a role in HIV spread.

项目摘要 艾滋病毒仍然是整个撒哈拉以南非洲的重大公共卫生问题，包括马拉维。 性传播感染（STI）护理设置未充分利用的场所，仅仅到达 艾滋病毒（PWH）和艾滋病毒高风险的人不受限制的人，有可能优化艾滋病毒 预防和治疗结果。在马拉维和人们中有危险的饮酒是广泛的 接受STI护理，这是预防艾滋病毒成功率成功的关键障碍。待遇是简短的，高度 有效，文化适当，可扩展，基于证据的干预措施（EBI），以减少酒精。尽管 在文化上适合潜水员环境，尚未适应转变的艾滋病毒护理环境 其中包括PWH和艾滋病毒高风险的人。通过初步工作，我们的团队已经证明了 那就是：1）在包括马拉维在内的SSA接受性传播感染护理的人中，有害饮酒非常普遍； 2）治疗在文化上是适当的，可行的，可接受的，并且有效地减少酒精的使用和改善 在全球环境中，包括SSA在内的PWH之间的病毒抑制； 3）成功带领酒精 减少和艾滋病毒预防以及治疗效果和实施研究。总体目标 R34的应用是为了产生一种文化适应的，可扩展的HIV“状态中性” EBI，以减少酒精和 在R01混合有效性试验中测试HIV预防和治疗优化。我们将 进行2臂飞行员随机对照试验（RCT），将治疗4与通常的护理进行比较以评估 在一个STI护理环境中，预防艾滋病毒和治疗的初步效率和实施 作为马拉维利隆威市的早期暴露前预防（PREP）实施部位。从 我们以前的手动干预措施，我们将制定三局干预措施，即 预防和治疗咨询以改善艾滋病毒预防结果的治疗 - PREP使用 有PWH的艾滋病毒和病毒抑制的风险。我们的具体目的是1）适应Treat，EBI 减少酒精，以整合艾滋病毒状态中性咨询（Pret4All）的PWH和艾滋病毒高风险的艾滋病咨询 报告大量饮酒并在马拉维接受性传播疾病护理； 2）评估短期效率和 实施治疗4ALL以优化预防HIV和治疗结果（抑制病毒 PWH;在过去30天内的艾滋病毒高风险的人和大量饮酒日的比例中使用； 3） 探索干预参与者中治疗4的响应能力的途径。结果将具有相关性 将减少酒精的EBIS整合到现实世界中的STI护理环境中，以优化预防HIV和 整个撒哈拉以南非洲和酒精在艾滋病毒中发挥作用的地区的治疗计划 传播。