TRUST

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• 批准号: 8298868
• 负责人: WILLIAM Albert BLATTNER
• 金额: $ 96.76万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-18 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8298868
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Anti-Retroviral Agents; Area; Behavioral; Biological; Caring; Characteristics; Client; Client satisfaction; Clinical; Clinical Competence; Clinical Services; Cohort Studies; Collaborations; Communication; Communities; Community Outreach; Comorbidity; Comprehensive Health Care; Education; Effectiveness; Ego; Elements; Enrollment; Epidemic; Evaluation; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Healthcare; Human immunodeficiency virus test; Impact evaluation; Individual; Infection prevention; Institution; Intervention; Link; Low income; Lubricants; Measurable; Measures; Mediating; Medical; Methods; Modeling; Modification; Monitor; Network-based; Nigeria; Operations Research; Outcome; Output; Pattern; Population; Prevention; Preventive Intervention; Primary Health Care; Provider; Recruitment Activity; Respondent; Risk; Risk Assessment; Risk Behaviors; Role; Sampling; Screening procedure; Services; Sex Behavior; Sexually Transmitted Diseases; Site; Structure; Support Groups; Testing; Time; Trust; United States National Institutes of Health; base; behavior influence; common treatment; condoms; effectiveness measure; high risk sexual behavior; implementation science; innovation; member; men who have sex with men; outreach; peer; prevent; prevention service; programs; prospective; response; social; tool; transmission process; treatment response; uptake; volunteer

DESCRIPTION (provided by applicant): The Office of Global AIDS Coordinator (OGAC) Technical Guidance on Combination HIV Prevention defines a comprehensive HIV-prevention services program for MSM and their partners. The current proposal, "Network-Based Recruitment of MSM into HCT, Care, Treatment and Prevention Services at Trusted Community-based Venues" (TRUST) conducts an operations research prospective cohort study that evaluates an intervention that engages each element of the OGAC program in an integrated service model. The central hypothesis of TRUST is that Network-based recruitment to expand engagement of Nigerian MSM that links clients to combination prevention and comprehensive HIV and medical services delivered at community-trusted venues achieves measurable behavioral change, and durable high quality clinical outcomes. The three aims of TRUST are: 1) To evaluate Respondent Driven Sampling (RDS) as a recruitment tool, define barriers to HCT and service engagement and quantify acceptability of test and treat; 2) Measure the impact of the TRUST intervention on prevention outcomes; 3) Define the optimal service delivery model. To achieve these aims TRUST engages RDS, a mathematically defined peer-driven chain referral method to recruit 1200 clients from the MSM communities of Abuja and Lagos into a comprehensive service delivery at MSM community-based trusted venues. Barriers to HCT and treatment uptake are quantified. Validated behavioral and innovative ego network risk assessment tools previously developed by the investigative team in other low income settings are employed to measure patterns of behavior and sexual practice among MSM in Nigeria, and monitor impact of TRUST engagement on behavioral and biological (incident HIV and STI) outcomes. A particular focus is the role of network relationships in influencing behaviors and the potential of TRUST to understand and strengthen favorable peer-mediated behavioral norms. Given the propensity of structured HIV prevention interventions to lose effectiveness over time, the TRUST model, linking intensive combination prevention interventions to ongoing comprehensive clinical service delivery in MSM community "owned" venues is a platform that potentially reinforces sustained and lasting behavioral change that is mutually reinforced by members of "cohesive" sexual networks. Optimization of clinical service delivery is evaluated through objective clinical (e.g. treatment response, adherence), provider (clinical competence), site (impact of peer "task shifting") and client (satisfaction) analyses. Th outputs of the TRUST initiative are: 1) expanded understanding of the extent of MSM social and sexual networks in Nigeria; 2) the drivers of risk practices and their modification; 3) the impact f HIV and STI treatment and combination prevention to reduce high risk behaviors and sexual practices; 4) an objective assessment of the quality of HIV and medical services delivered in a nontraditional venue. Together this information will guide institution of best practices for scale p of TRUST as a PEPFAR model of service delivery with the potential for high impact. PUBLIC HEALTH RELEVANCE: The TRUST project, conducted in Nigeria which is second in the world for HIV, evaluates the impact of providing comprehensive and integrated prevention, treatment and care at community venues operated by local organizations supportive of men who have sex with men. The study investigates the impact on promoting safe sexual behaviors on the reduction of HIV infections and the impact of treatment to prevent AIDS. If the model is successful it can be expanded to support PEPFAR goals for prevention, care and treatment for marginalized populations, who continue to be significant drivers of the HIV/AIDS epidemic.

描述（由申请人提供）：全球艾滋病协调员办公室 (OGAC) 艾滋病毒综合预防技术指南为 MSM 及其合作伙伴制定了全面的艾滋病毒预防服务计划。当前的提案“基于网络招募 MSM 在受信任的社区场所进行 HCT、护理、治疗和预防服务”(TRUST) 进行了一项运筹学前瞻性队列研究，该研究评估了将 OGAC 计划的每个要素纳入其中的干预措施一体化的服务模式。 TRUST 的核心假设是，基于网络的招聘扩大了尼日利亚 MSM 的参与，将客户与社区信任的场所提供的联合预防和全面的艾滋病毒和医疗服务联系起来，实现了可衡量的行为改变和持久的高质量临床结果。 TRUST 的三个目标是： 1) 评估受访者驱动抽样 (RDS) 作为招募工具，确定 HCT 和服务参与的障碍，并量化测试和治疗的可接受性； 2) 衡量 TRUST 干预对预防结果的影响； 3) 定义最佳服务交付模型。为了实现这些目标，TRUST 采用 RDS，这是一种数学定义的同行驱动链推荐方法，从阿布贾和拉各斯的 MSM 社区招募 1200 名客户，在基于 MSM 社区的可信场所提供全面的服务。对 HCT 和治疗采用的障碍进行了量化。调查团队先前在其他低收入环境中开发了经过验证的行为和创新的自我网络风险评估工具，用于衡量尼日利亚 MSM 的行为模式和性行为，并监测 TRUST 参与对行为和生物（艾滋病毒和性传播感染事件）的影响）结果。特别关注的是网络关系在影响行为中的作用以及信任在理解和加强有利的同伴介导的行为规范方面的潜力。鉴于结构化的艾滋病毒预防干预措施随着时间的推移会失去效力，TRUST 模型将密集的组合预防干预措施与 MSM 社区“拥有的”场所中持续提供的综合临床服务联系起来，是一个可能加强持续和持久的行为改变的平台，这种改变是相互影响的。由“有凝聚力的”性网络成员加强。临床服务提供的优化是通过客观临床（例如治疗反应、依从性）、提供者（临床能力）、地点（同行“任务转移”的影响）和客户（满意度）分析来评估的。 TRUST 倡议的成果是： 1) 扩大了对尼日利亚 MSM 社交和性网络范围的了解； 2）风险实践的驱动因素及其修改； 3）艾滋病毒和性传播感染治疗和综合预防对减少高危行为和性行为的影响； 4) 对非传统场所提供的艾滋病毒和医疗服务的质量进行客观评估。这些信息将共同指导建立 TRUST 规模 p 的最佳实践，作为 PEPFAR 服务提供模式，具有巨大影响力。 公共卫生相关性：该信托项目在世界第二艾滋病毒感染国尼日利亚进行，评估了在支持男男性行为的当地组织运营的社区场所提供全面综合的预防、治疗和护理的影响。 该研究调查了促进安全性行为对减少艾滋病毒感染的影响以及预防艾滋病治疗的影响。 如果该模式成功，它可以扩展到支持总统紧急救援计划（PEPFAR）针对边缘人群的预防、护理和治疗目标，这些人群仍然是艾滋病毒/艾滋病流行的重要推动因素。