Understanding Viral Suppression for Newly Diagnosed HIV+ Men to Inform Implementation of TasP and U=U

了解新诊断的 HIV 男性的病毒抑制，为 TasP 和 U=U 的实施提供信息

基本信息

批准号：
10361553
负责人：
H. Jonathon Rendina
金额：
$ 111.59万
依托单位：
WHITMAN-WALKER INSTITUTE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-03-24 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10361553
关键词：
AIDS prevention Address Adherence Advocacy American Back Behavioral Biological Bisexual Blood Caring Centers for Disease Control and Prevention (U.S.)Clinical Clinical Trials Complement Consensus Continuity of Patient Care Couples Data Reporting Diagnosis Drops Early Intervention Empirical Research Enrollment Epidemic Epidemiology Event Financial compensation Focus Groups Future Gays General Population Goals Guidelines HIV HIV Infections HIV Seronegativity HIV Seropositivity HIV diagnosis Health Health Personnel Home Individual Infection Intervention Interview Lead Link Location Methods Modeling Monitor Morbidity - disease rate Movement National Institute of Allergy and Infectious Disease National Institute of Child Health and Human Development National Institute of Mental Health Nature Newly Diagnosed Outcome Patient Self-Report Pattern Persons Phase Population Provider Public Health Qualitative Methods Research Resistance Risk Risk Factors Safety Sampling Sex Behavior Spottings Study models Surveys Time TimeLine Translating Treatment Efficacy United States National Institutes of Health Viral Viral Load result antiretroviral therapy base care providers cohort critical period design efficacy validation high risk implementation barriers improved improved outcome indexing insight men men who have sex with men men&apos s group minority stress mortality psychosocial recruit resilience routine practice scale up sexual HIV transmission sexual minority health sexual minority men social success surveillance data theories therapy adherence therapy development transmission process treatment as prevention uptake virtual

项目摘要

Project Summary Gay and bisexual men and other sexual minority men (SMM) in the U.S. are burdened by a high and disproportionate rate of HIV infection. Improving outcomes of the HIV Care Continuum through to maintaining viral load (VL) suppression is associated with a significant reduction in the sexual transmission of HIV and significantly better long-term health outcomes. However, little research provides insight into the preventable structural, psychosocial, and behavioral factors that influence durable VL suppression during early infection that can be used in developing effective early intervention strategies. Moreover, the successful implementation of TasP and U=U messaging is a necessary component of the strategy to end the HIV epidemic, but rigorous research is needed to address real-world implementation issues, including safety concerns and perceived barriers among key stakeholder populations. We aim to address these issues with two studies grounded in the Social Ecological Model (SEM) to simultaneously examine both VL suppression and implementation barriers surrounding U=U from multiple levels of influence. Specifically, Aim 1 of the study is to examine time to initial VL suppression and patterns in VL rebound to better understand the dynamic nature of VL suppression and use the SEM along with an intersectional minority stress framework to longitudinally investigate structural, psychosocial, and behavioral factors associated with VL suppression among SMM to better understand risk and resilience. Next, Aim 2 is to examine how adherence and perceived VL status are associated with objective VL status and whether concordance between perceived and actual VL suppression influences sexual risk compensation as captured by event-level sexual behaviors and STI infections. Finally, Aim 3 is designed to understand ongoing barriers to implementing U=U from the perspectives of the three populations critical to its successful implementation among SMM—namely, SMM living with HIV, HIV-negative SMM, and HIV care providers. To do so, Study 1 (Aims 1 and 2) will leverage two LITE cohorts to recruit 250 SMM newly diagnosed with HIV during the course of the studies—we will follow these men for two years immediately following diagnosis, collecting home-based dried blood spot for VL on a monthly basis to examine the dynamic nature of VL suppression. In addition to VL and self-reported data, the study will include objective indicators of adherence and care engagement as well as qualitative interviews. The goal of Study 1 will be to identify risk and resilience factors that influence VL suppression and can be used to guide future intervention development (Aim 1) while simultaneously addressing understudied safety concerns of implementing U=U with regard to unintended risks (Aim 2). In Study 2 (Aim 3), we will use focus groups conducted three times over five years to inform implementation of U=U messaging. Achieving the aims of the proposed study will provide key insights that will be critical for translating to or adapting interventions to enhance their potency and durability and improve the health of SMM living with HIV and curb new infections.

项目概要美国的男同性恋者和双性恋者以及其他性少数男性 (SMM) 承受着较高的负担改善艾滋病毒护理连续体的结果，直至维持不成比例的艾滋病毒感染率。病毒载量 (VL) 抑制与 HIV 性传播的显着减少有关，并且然而，很少有研究深入了解可预防的因素。影响早期感染期间持久 VL 抑制的结构、社会心理和行为因素此外，可用于制定有效的早期干预策略。 TasP 和 U=U 信息传递是结束艾滋病毒流行战略的必要组成部分，但严格需要进行研究来解决现实世界的实施问题，包括安全问题和感知问题我们的目标是通过两项基于以下方面的研究来解决这些问题。社会生态模型 (SEM) 同时检查 VL 抑制和实施障碍具体来说，该研究的目标 1 是检查初始时间。 VL 抑制和 VL 反弹模式，以更好地了解 VL 抑制和 VL 抑制的动态性质使用 SEM 和交叉少数应力框架来纵向研究结构、 SMM 中与 VL 抑制相关的社会心理和行为因素，以更好地了解风险接下来，目标 2 是检查依从性和感知的 VL 状态如何关联。客观 VL 状态以及感知和实际 VL 抑制之间的一致性是否影响性最后，目标 3 旨在实现事件级性行为和性传播感染的风险补偿。从三个群体的角度来看，实施 U=U 的持续障碍，以了解对其至关重要的在 SMM 中成功实施，即艾滋病毒感染者 SMM、艾滋病毒阴性 SMM 和艾滋病毒护理为此，研究 1（目标 1 和 2）将利用两个 LITE 队列新招募 250 名 SMM。在研究过程中被诊断出患有艾滋病毒——我们将立即跟踪这些人两年诊断后，每月采集家庭干血斑进行VL检查动态除了 VL 和自我报告的数据外，该研究还将包括 VL 抑制的客观指标。研究 1 的目标是识别风险。影响 VL 抑制并可用于指导未来干预措施发展的弹性因素（目标 1）同时解决实施 U=U 方面尚未充分研究的安全问题意外风险（目标 2）在研究 2（目标 3）中，我们将利用五年内进行 3 次的焦点小组来评估意外风险。为 U=U 消息传递的实施提供信息。实现拟议研究的目标将提供关键见解。这对于转化或调整干预措施以增强其效力和持久性至关重要，改善艾滋病毒感染者 SMM 的健康并遏制新的感染。