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.

项目概要 艾滋病毒仍然是整个撒哈拉以南非洲地区的一个重大公共卫生问题，包括马拉维。 性传播感染 (STI) 护理机构未充分利用同时传播病毒的场所 未受抑制的艾滋病毒感染者 (PWH) 和艾滋病毒高危人群，并且有潜力优化艾滋病毒 有害酒精的使用在马拉维和人们中很普遍。 接受性传播感染护理是艾滋病毒预防工作取得巨大成功的一个关键障碍。 有效的、文化上适当的、可扩展的、基于证据的干预措施（EBI）。 TrEAT 在文化上适合不同的环境，尚未适应不断变化的艾滋病毒护理环境 通过初步工作，我们的团队已经证明，其中包括艾滋病毒感染者和艾滋病毒高危人群。 1) 在撒哈拉以南非洲地区（包括马拉维）接受性传播感染护理的人群中，有害饮酒的情况非常普遍； 2) TrEAT 在文化上是适当的、可行的、可接受的，并且能有效减少饮酒和改善 全球各地（包括 SSA）的感染者病毒抑制；以及 3) 成功引导酗酒； 减少艾滋病毒预防和治疗效果及实施研究的总体目标。 R34 应用程序旨在产生一种适应文化、可扩展的 HIV“状态中立”EBI，用于减少酒精摄入和 我们将在 R01 混合有效性实施试验中测试艾滋病毒预防和治疗优化。 进行一项 2 组试点随机对照试验 (RCT)，将 TrEAT4All 与常规护理进行比较，以评估 在一个性传播感染护理机构内艾滋病毒预防和治疗的初步效果和实施情况 位于马拉维利隆圭的早期暴露前预防 (PrEP) 实施地点。 与我们之前的手动干预措施相比，我们将开发一个 3 疗程的干预措施 TrEAT4All，其中整合了 HIV TrEAT 的预防和治疗咨询可改善 HIV 预防结果——PrEP 的使用 我们的具体目标是 1) 调整 TrEAT，这是一种针对感染者的 EBI。 减少饮酒，为感染者和艾滋病毒高危人群提供艾滋病毒状态中立咨询 (TrEAT4All) 报告酗酒并正在马拉维接受性传播感染护理的人 2) 评估短期疗效和 实施 TrEAT4All 以优化艾滋病毒预防和治疗结果（病毒抑制 艾滋病毒感染者 (PWH) 的使用情况以及过去 30 天内大量饮酒的天数比例；3) 探索干预参与者中 TrEAT4All 反应的途径，结果将具有相关性。 将减少饮酒 EBI 融入现实世界的性传播感染护理环境中，以优化艾滋病毒预防和 整个撒哈拉以南非洲和其他酒精在艾滋病毒中起作用的地区的治疗计划 传播。