Characterizing PrEP Adherence and Patterns of Use in a Diverse Community Cohort of Young Men

描述不同社区年轻男性群体的 PrEP 依从性和使用模式

基本信息

批准号：
9892888
负责人：
Brian Mustanski
金额：
$ 49.67万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2022-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9892888
关键词：
AIDS prevention Adherence Adult Age Awareness Behavior Therapy Biological Markers Blood Cohort Studies Color Communities Data Data Collection Development Diphosphates Dose Effectiveness Erythrocytes Ethnic Origin Evaluation Event Exhibits Financial compensation Funding Goals HIV HIV Infections HIV risk Individual Infection Intervention Interview Investigation Knowledge Laboratories Latino Life Measures Methods National Institute of Drug Abuse Observational Study Oral Participant Patient Self-Report Pattern Population Predictive Factor Prevention approach Preventive Public Health Race Recording of previous events Reporting Research Research Methodology Risk Risk Behaviors Sampling Sex Behavior Spottings Structure Tenofovir Testing Time Translating Work Youth aged cohort condomless anal sex condoms diaries ethnic difference health disparity high risk high risk men improved interest novel open label pre-exposure prophylaxis protective effect racial and ethnic racial and ethnic disparities racial difference racial disparity recruit sexual risk behavior transmission process trend tripolyphosphate uptake young man young men who have sex with men

项目摘要

Project Summary Young men who have sex with men (YMSM) are at high risk for HIV–particularly YMSM of color. Pre-exposure prophylaxis (PrEP) is extremely effective at reducing HIV transmission. Uptake has been lower than anticipated, but is increasing rapidly–though less so among Black YMSM. PrEP effectiveness hinges upon adherence, but levels of adherence vary and tend to be lower among Black individuals and youth. Adherence to daily PrEP does not need to be perfect to obtain benefit–in the iPrEx open-label extension, taking 2-3 doses/week was 84% efficacious (4+ was 100% efficacious)–and non-daily dosing strategies are also under investigation (event- and time-driven dosing). Beyond adherence, patterns of use are critically important. Oral PrEP is unlikely to be a life-long strategy for most, and evidence suggests that many YMSM discontinue PrEP (particularly Black and Latino YMSM), but most discontinuers report continued HIV risk behaviors. Further, studies are beginning to examine episodic PrEP use during discrete periods of highest HIV risk. Finally, risk compensation (i.e., decreased condom use after initiating PrEP) is a crucial component of PrEP effectiveness as it may maintain, or even increase, HIV transmission if adherence is not optimal. The goal of the current proposal is to characterize PrEP adherence across dosing strategies, describe patterns of use (continuous, episodic, discontinuation), and examine racial differences in adherence and patterns of use. We will embed novel mixed-methods research into RADAR, a diverse cohort of YMSM (N>1,200; age 16-29) assessed every 6 months (U01DA036939). We propose to add a daily diary study of PrEP users to characterize adherence and patterns of use, biomarkers of adherence to objectively measure PrEP coverage, and in-depth interviews with PrEP users to understand contextual influences on these issues. Aim 1: Describe PrEP adherence, dosing strategies, and usage patterns among YMSM. We will conduct a 3-month daily diary study with 120 YMSM PrEP users from RADAR to: a) characterize patterns of PrEP dosing strategies (daily, time-driven, event- driven), adherence, and usage patterns (continuous, episodic, discontinuation); b) Examine whether PrEP adherence or dosing strategies are associated with self-reported sexual risk behavior and STI infection; and c) describe racial differences in PrEP adherence, dosing strategies, and risk compensation. Aim 2: Assess associations between usage patterns and long- and short-term concentrations of PrEP in red blood cells. We will collect dried blood spot samples once per month during the diary study (3x) to assess concentrations of tenofovir-diphosphate and embtricitabine-triphosphate. Aim 3: Characterize YMSM perspectives on adherence, usage patterns, and risk compensation. We will conduct in-depth interviews with 60 YMSM diary study participants to understand individual, interpersonal, and structural influences on PrEP adherence and patterns of use, with an emphasis on understanding racial differences. Data from this study will inform the development of public health messaging and behavioral interventions to improve PrEP effectiveness among diverse YMSM.

项目概要男男性行为者 (YMSM) 感染艾滋病毒的风险很高，尤其是有色人种的 YMSM。预防 (PrEP) 在减少 HIV 传播方面极为有效。预计，但正在迅速增加——尽管黑人 YMSM 的增加程度较低，但 PrEP 的有效性取决于。依从性，但黑人和青少年的依从性水平各不相同，而且往往较低。每日 PrEP 无需完美即可获得益处——在 iPrEx 开放标签扩展中，服用 2-3 每周剂量为 84% 有效（4+ 为 100% 有效）——非每日给药策略也在研究中调查（事件和时间驱动的剂量）除了坚持之外，口服使用模式也至关重要。 PrEP 不太可能成为大多数人的终生策略，有证据表明许多 YMSM 停止 PrEP （特别是黑人和拉丁裔 YMSM），但大多数戒断者报告持续存在艾滋病毒危险行为。研究开始检验在 HIV 风险最高的离散时期的间歇性 PrEP 使用情况。补偿（即开始 PrEP 后减少安全套的使用）是 PrEP 有效性的重要组成部分因为如果依从性不理想，它可能会维持甚至增加艾滋病毒的传播当前的目标。提案的目的是描述 PrEP 跨剂量策略的依从性，描述使用模式（连续、间歇性、终止），并检查我们将嵌入的依从性和使用模式的种族差异。针对 RADAR 的新颖混合方法研究，YMSM 的多元化队列（N>1,200；年龄 16-29）评估了每个 6 个月 (U01DA036939) 我们建议添加 PrEP 用户的每日日记研究来描述依从性。和使用模式、客观衡量 PrEP 覆盖率的生物标志物以及深入访谈与 PrEP 用户一起了解这些问题的背景影响目标 1：描述 PrEP 依从性和剂量。 YMSM 的策略和使用模式我们将对 120 个 YMSM 进行为期 3 个月的每日日记研究。 RADAR 的 PrEP 用户可以： a) 描述 PrEP 剂量策略的模式（每日、时间驱动、事件驱动） b) 检查 PrEP 是否依从性或剂量策略与自我报告的性危险行为和性传播感染有关；c) 描述 PrEP 依从性、剂量策略和风险补偿方面的种族差异。使用模式与红细胞中 PrEP 的长期和短期浓度之间的关联。在日记研究期间每月收集一次干血斑样本 (3x)，以评估目标 3：描述 YMSM 对依从性的看法。我们将对60位YMSM日记进行深度访谈研究。参与者了解个人、人际和结构对 PrEP 依从性和模式的影响使用，重点是了解种族差异。这项研究的数据将为开发提供信息。公共卫生信息传递和行为干预措施，以提高不同 YMSM 之间的 PrEP 有效性。