Stigma and Substance Use as Barriers to PrEP Linkage, Uptake, Adherence, and Persistence among BMSM

污名和物质使用是 BMSM 之间 PrEP 联系、吸收、坚持和持久性的障碍

• 批准号: 10402891
• 负责人: Lisa A Eaton
• 金额: $ 62.21万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402891
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Affect; Awareness; Behavior; Behavioral; Biological; Biological Markers; Blood; COVID-19; COVID-19 impact; Caring; Centers for Disease Control and Prevention (U.S.); Cocaine; Connecticut; Continuity of Patient Care; Counseling; Data; Drug abuse; Eligibility Determination; Enrollment; Ethnic Origin; Failure; Follow-Up Studies; Guidelines; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV risk; HIV/STD; Healthcare; Heroin; Human immunodeficiency virus test; Incidence; Individual; Infrastructure; Inhalant dose form; Intervention; Left; Longitudinal Studies; Measures; Mediating; Modeling; Nitrates; Opioid; Outcome; Participant; Pathway interactions; Population; Positioning Attribute; Prevalence; Prevention approach; Procedures; Process; Prospective cohort; Psychosocial Assessment and Care; Public Health; Race; Reporting; Research; Risk; Role; Sex Behavior; Site; Southeastern United States; Spottings; Testing; Toxicology; Translating; Treatment Efficacy; United States National Institutes of Health; Universities; Vulnerable Populations; Work; base; black men who have sex with men; ecstasy; efficacy testing; evidence base; health care availability; improved; insight; interest; intersectionality; marijuana use; men who have sex with men; novel; pre-exposure prophylaxis; prevent; racial disparity; recruit; response; sexually active; social stigma; social structure; substance use; substance user; transmission process; uptake

This application is in response to PAS-18-915 HIV/AIDS High Priority Drug Abuse Research. HIV incidence among Black men who have sex with men (BMSM) in the southeastern United States is one of the highest in the world. Our research team has conducted studies with BMSM in Atlanta that have demonstrated 35% HIV prevalence and over 5% annual HIV incidence. Although PrEP is highly effective for preventing HIV transmission, it is not reaching BMSM. The failures in our ability to engage BMSM in PrEP use are highly problematic given the alarming rates of HIV transmission among this group. In our most recent work with BMSM in Atlanta, we found that only 4% (n=19/474) of BMSM are currently taking PrEP even though 90% (n=428/474) are aware of PrEP. Of particular concern is the impact of substance use as a barrier in PrEP linkage, uptake, adherence, and persistence. Substance use is common among BMSM in our study, with 43% (n=204/474) reporting recent substance use. And, critically, in our most recent longitudinal study with BMSM, substance users were more than twice as likely than non-substance users to test HIV positive, 7% (n=15/205) vs. 2% (n=4/244) at baseline testing, and an additional 7% (n=13/190) vs 3% (n=8/240) at study follow up one year later. Further complicating PrEP use is the potential impact of COVID- 19 on health care access, health care infrastructure, and sex behavior. The need to better understand PrEP use in the context of our new health care landscape is critical to making advances in PrEP use. At this point, assessing how substance use impacts PrEP use is challenging because PrEP implementation is so low among this group. The proposed research aims to provide substance using BMSM with evidence-based PrEP engagement counseling to address barriers to accessing PrEP (not for intervention testing, but for facilitating PrEP use) and to assess the multiple forms and paths of stigma and substance use as they relate to PrEP linkage, uptake, adherence, and persistence. We propose using the HIV Stigma Framework as a conceptual model for investigating the intersecting pathways of stigma drivers and stigma mechanisms as they relate to PrEP use among substance using BMSM. Aim 1: Enroll a prospective cohort of N=500 BMSM who test HIV negative and test substance use positive on toxicology testing, and provide evidence-based PrEP engagement counseling to facilitate access to PrEP care. Aim 2: Conduct psychosocial and health care access assessments every 2-months for 18-months, and conduct HIV/STI testing and dried blood spot testing for TFV-DP every 3-months for 18-months. Aim 3: Using data collected from Aims 1 and 2, model stigma pathways of advancing and reverting along the PrEP cascade (i.e., linkage, uptake, adherence, persistence), with these pathways mediated by health care access and moderated by substance use. Achieving the aims will provide critical insight for translating and adapting interventions to enhance potency and durability for individuals at exceedingly elevated risk for HIV.

该应用是对PAS-18-915 HIV/AIDS高优先药物滥用研究的响应。艾滋病毒发病率 在美国东南部与男性发生性关系的黑人中， 世界。我们的研究团队已向亚特兰大的BMSM进行了研究，这些研究表现出35％的艾滋病毒 患病率和超过5％的年HIV发病率。尽管PREP非常有效地预防艾滋病毒 传输，它没有达到BMSM。我们参与BMSM进行准备的能力的失败是高度的 鉴于该组中的艾滋病毒传播率令人震惊。在我们最近的工作中 亚特兰大的BMSM，我们发现，尽管目前只有4％（n = 19/474）的BMSM进行准备 90％（n = 428/474）意识到准备。特别关注的是用作物质用作障碍的影响 准备连接，吸收，依从性和持久性。在我们的研究中，在BMSM中使用药物很常见， 43％（n = 204/474）报告最近使用物质。而且，在我们的最新纵向研究中，批判性 使用BMSM，药物用户的测试艾滋病毒的可能性是非固定用户的两倍以上 阳性，7％（n = 15/205）和基线测试时2％（n = 4/244），另外7％（n = 13/190）vs 3％ （n = 8/240）一年后的研究随访。进一步复杂的准备使用是共证的潜在影响 19关于医疗保健，医疗保健基础设施和性行为。需要更好地理解准备 在我们的新医疗保健领域的背景下，对于提高准备使用方案至关重要。在此刻， 评估物质使用的影响如何使用PrEP使用具有挑战性，因为PrEP实施在 这个小组。拟议的研究旨在使用BMSM和基于证据的PREP提供物质 参与咨询以解决访问PREP的障碍（不是用于干预测试，而是用于 促进准备使用）并评估污名和物质使用的多种形式和路径 与准备连接，吸收，依从性和持久性有关。我们建议使用HIV污名框架 作为研究污名驱动因素和污名的相交途径的概念模型 与使用BMSM在物质之间使用的机制相关的机制。目标1：注册潜在的队列 n = 500 bmsm的毒害测试和测试物质在毒理学测试上使用阳性，并提供 基于证据的准备参与咨询，以促进获得准备护理。目标2：进行社会心理 和医疗保健访问评估每2个月，每2个月一次，进行艾滋病毒/STI测试并干燥 TFV-DP的血点测试每3个月进行18个月。目标3：使用目标1和2收集的数据， 沿着准备级联进步和恢复的模型污名途径（即链接，摄取，依从性， 持久性），这些途径是由医疗保健访问介导的，并通过药物使用而进行了调节。 实现目标将为翻译和适应干预措施的关键见解以提高效力 艾滋病毒风险极高的人的耐用性。