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）艾滋病毒联合预防的技术指南定义了针对MSM及其合作伙伴的全面艾滋病毒预防服务计划。当前的提案“基于网络的MSM招募了基于信任的社区的HCT，护理，治疗和预防服务”（Trust）进行了一项运营研究的前瞻性队列研究，该研究评估了一项干预措施，该干预措施在集成服务模型中参与OGAC计划的每个元素。信任的核心假设是，基于网络的招聘扩大了尼日利亚MSM的参与度，该招聘将客户与预防预防和全面的艾滋病毒和医疗服务联系起来，并在社区信任的场所提供了可衡量的行为变化，以及持久的高质量临床结果。信任的三个目标是：1）评估受访者驱动的抽样（RDS）作为招聘工具，定义HCT和服务参与的障碍，并量化测试和治疗的可接受性； 2）衡量信托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，信托与RDS相关，是一种数学定义的同行驱动的连锁转介方法，可从阿布贾和拉各斯的MSM社区招募1200个客户，成为基于MSM社区的受信任场所的全面服务交付。量化HCT和治疗摄取的障碍。通过调查团队在其他低收入环境中开发的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之间的行为和性行为模式，并监控信任参与对行为和生物学（事件HIV和STI）的影响。一个特定的重点是网络关系在影响行为的作用以及信任理解和加强同伴介导的行为规范的潜力。鉴于结构化的HIV预防干预措施随着时间的流逝而失去有效性的倾向，将强化组合预防干预措施与MSM社区“拥有”场地的持续全面临床服务提供联系的信任模型是一个潜在地增强持续和持久的行为变化的平台，该平台由“共振”性网络成员相互加强。通过客观的临床（例如治疗反应，依从性），提供商（临床能力），站点（同伴“任务转移”的影响）和客户（满意度）分析来评估临床服务提供的优化。信托计划的产出是：1）扩大对尼日利亚MSM社会和性网络程度的了解； 2）风险做法的驱动因素及其修改； 3）影响HIV和STI治疗以及预防组合，以减少高风险行为和性行为； 4）对非传统场所提供的艾滋病毒和医疗服务质量的客观评估。这些信息将共同指导最佳实践的信任规模P，作为服务交付的PEPFAR模型，具有高影响力。 公共卫生相关性：该信托项目在尼日利亚进行的艾滋病毒是尼日利亚进行的，它评估了在当地组织经营的社区场所提供全面和综合的预防，治疗和护理的影响，该组织支持与男性发生性关系的当地组织。 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的治疗的影响。 如果该模型成功，可以扩展，以支持边缘化人群的预防，护理和治疗目标，他们继续成为艾滋病毒/艾滋病流行的重要驱动力。