In-depth Understanding of HIV Risk Behavior among Men Who Have Sex With Men in Sub-Saharan Africa: Secondary Analysis of HPTN 075 Data

深入了解撒哈拉以南非洲地区男男性行为者的艾滋病毒风险行为：HPTN 075 数据的二次分析

• 批准号: 10645082
• 负责人: Theodorus G.M. Sandfort
• 金额: $ 24.02万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10645082
• 关键词: AIDS prevention; Address; Affect; Africa South of the Sahara; Age; Anal Sex; Behavior assessment; Characteristics; Clinical assessments; Communities; Counseling; Country; Data; Data Analyses; Data Set; Development; Drug resistance; Enrollment; Ensure; Epidemic; General Population; HIV; HIV Infections; HIV Seropositivity; HIV prevention trials network; HIV risk; High Prevalence; Human immunodeficiency virus test; Immune; Improve Access; Incidence; Individual; Infectious Diseases Research; Intervention; Kenya; Knowledge; Legal Status; Malawi; Mediating; Motivation; Outcome Study; Paper; Participant; Pattern; Peer Review; Persons; Population; Preparation; Prevalence; Publications; Publishing; Reporting; Research; Risk; Risk Behaviors; Role; Safe Sex; Same-sex; Sampling; Sex Behavior; Sex Counseling; Sexuality; Site; South Africa; Subgroup; Testing; Transact; Visit; Woman; Work; biobehavior; cohort; condomless anal sex; condoms; design; evidence base; follow-up; high risk population; implementation science; interest; longitudinal design; meetings; men; men who have sex with men; men who have sex with men and women; patient engagement; prevent; preventive intervention; prospective; recruit; resistance mutation; response; risk perception; screening; screening participation; secondary analysis; sex; sexual encounter; social; substance use; substance user; tool; transmission process; virtual

The aim of this project is to use the rich data collected for the HIV Prevention Trials Network (HPTN) 075 study to expand our understanding of the sexual behavior and HIV risk practices of men who have sex with men (MSM) in sub-Saharan Africa (SSA). HPTN 075 was a vanguard study with the primary aim to assess the feasibility of recruiting and retaining 400 men who have sex with men (MSM) in sub-Saharan Africa (SSA) in preparation for further HIV prevention studies. This aim was successfully addressed in a multinational, prospective biobehavioral cohort with five study visits over a one-year follow-up period. Each study visit included behavioral and clinical assessments. The study was conducted from 2015 to 2017 in four sites: Blantyre in Malawi, Kisumu in Kenya, and Cape Town and Soweto in South Africa. HPTN 075 showed an alarmingly high HIV prevalence and incidence among MSM in SSA: 30% of all MSM screened for participation tested HIV positive and an overall incidence was found of 7.0/100 person-years (PY) (95% CI: 4.3, 10.6). Engagement in condomless anal intercourse was the strongest determinant of incidence. The HPTN 075 data set is exceptionally rich: the involvement of four study sites in three countries; detailed assessments of sexual behavior, including on the dyad-level; and the longitudinal design with extensive screening data and five study visits. This rich data will be used to advance our understanding of factors that drive HIV transmission and that need to be addressed to end the HIV epidemic in SSA among MSM and, because of the high prevalence of MSM who also have sex with women, among the general population. The following questions will be answered: (1) Does engagement in condomless anal sex change over the duration of the study due to study-related HIV-risk counseling and improved access to condoms, and which characteristics of the individual (e.g., age, HIV risk perception), the sexual partnership (e.g., age concordance, relationship status), and the sexual encounter (e.g., substance use, place of interaction) are independently associated with condom use? (2) What are the features of sexual interactions that MSM have with women? How do their sexual interactions with men compare to the same-sex interactions of MSM who exclusively have sex with men? (3) What are the characteristics of MSM who engage in transactional sex and how do they differ from men who do not? How are transactional sex interactions different from sexual interactions that are not transactional, and in what way does receiving or providing benefits in exchange for sex affect these differences? (4) What patterns of substance use can be distinguished among MSM in SSA? Are these patterns predictive of HIV incidence and what is the mediating role of condomless receptive or insertive anal sex? (5) Are there differences between countries in sexual behaviors corresponding to the national differences in the legal status and social acceptance of same-sex sexuality? Findings from this study will inform the development of an implementation science study (R01) addressing the needs of MSM in SSA.

该项目的目的是将收集的丰富数据用于HIV预防试验网络（HPTN）075研究 扩大我们对与男性发生性关系的男性的性行为和艾滋病毒风险实践的理解（MSM） 在撒哈拉以南非洲（SSA）。 HPTN 075是一项先锋研究，主要目的是评估 在撒哈拉以南非洲（SSA）招募并保留400名与男性发生性关系的男性（MSM） 进一步的HIV预防研究。这个目标在跨国，前瞻性的生物行为中成功解决了 在一年的随访期间，有五次研究访问的队列。每次研究访问都包括行为和临床 评估。这项研究是从2015年到2017年在四个地点进行的：肯尼亚基苏木的布兰蒂尔， 以及南非的开普敦和索韦托。 HPTN 075表现出令人震惊的高HIV患病率，并且 SSA中MSM的发病率：筛选参与测试的HIV阳性的所有MSM的30％和总体 发现发病率为7.0/100人年（PY）（95％CI：4.3，10.6）。参与无避孕套肛门 性交是发病率最强的决定因素。 HPTN 075数据集非常丰富： 在三个国家 /地区参与四个研究地点；性行为的详细评估，包括 二元级；以及具有广泛筛选数据和五次研究访问的纵向设计。这个丰富的数据将是 用于促进我们对驱动艾滋病毒传播的因素的理解，需要解决以结束 MSM中SSA的艾滋病毒流行病，由于MSM的盛行率很高，他们也与 妇女，一般人口。以下问题将得到回答：（1）参与 由于研究相关的HIV风险咨询和 改善了获得避孕套的机会，以及个人的哪些特征（例如，年龄，艾滋病毒风险感知）， 性伙伴关系（例如年龄一致，关系状况）和性接触（例如，使用物质， 相互作用的地点）与使用避孕套独立相关吗？ （2）性的特征是什么 MSM与女性的互动？他们与男人的性互动与同性的性互动如何 MSM的互动，谁与男人发生性关系？ （3）参与的MSM的特征是什么 在交易性行为中，他们与没有的男人有何不同？交易性互动如何不同 从不是交易的性互动，以及以什么方式获得或提供福利 性别的交换会影响这些差异？ （4）可以区分MSM的物质使用模式 在SSA？这些模式是否可以预测艾滋病毒的发生率？无避孕套的介导作用是什么 还是插入肛交？ （5）国家的性行为与对应的国家行为之间存在差异 在同性性行为的法律地位和社会接受方面的国家差异？这项研究的结果 将为SSA中MSM需求的实施科学研究（R01）的发展提供信息。