Developing a U.S. National Cohort to Improve Virologic Suppression among Stimulant-using Men Living with HIV.

建立美国国家队列以改善使用兴奋剂的艾滋病毒男性感染者的病毒抑制。

基本信息

批准号：
10675863
负责人：
Adam Wayne Carrico
金额：
$ 105.44万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-05-15 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10675863
关键词：
2 arm randomized control trial 2019-nCoV Achievement Address Adherence Affect African American Behavior Therapy Black race Caring Clinical Research Cocaine Counseling Crack Cocaine Data Drug Monitoring Emotions Enrollment Epidemic Feedback Goals HIV HIV antiretroviral Hair Human immunodeficiency virus test Individual Intervention Maintenance Measures Methamphetamine Mobile Health Application Modeling Monitor Moods Motivation Namibia Nature Outcome Participant Patient Recruitments Patient Self-Report Persons Pharmaceutical Preparations Phase Pilot Projects Population Prevalence Randomized Randomized, Controlled Trials Research Sampling Self Administration Site Social Network Stimulant Structural Racism Subgroup Surveys Techniques Tenofovir Test Result Testing Therapeutic Time Underserved Population Urine Venous blood sampling Viremia Visit Work antiretroviral therapy cohort cost digital efficacy testing evidence base experience health care service utilization home test improved incremental cost intervention effect mHealth men men who have sex with men microcosting multi-component intervention novel point of care point of care testing primary outcome randomized, clinical trials recruit resilience response secondary outcome sexual minority men smartphone application social social stigma standard of care stimulant use structural determinants therapy adherence tool treatment adherence

项目摘要

PROJECT SUMMARY/ ABSTRACT A resurgent stimulant epidemic among sexual minority men/men who have sex with men, including those living with HIV, could compromise the U.S. Ending the HIV Epidemic goals by interfering with HIV care engagement, adherence, and virologic suppression among sexual minority men living with HIV. Prominent multi-level barriers interfere with HIV virologic suppression among sexual minority men living with HIV, particularly among those who use stimulants. We will digitally recruit at least 1,000 sexual minority men living with HIV, of whom at least 40% will identify as Black/African-American and at least 70% will have active stimulant use to identify multi-level determinants of HIV care engagement, adherence, and virologic suppression among sexual minority men living with HIV, with and without stimulant use. Guided by the social ecological model, we will investigate network factors (HIV status, stimulant use), geospatial determinants (background stimulant use prevalence, EHE region), and other structural factors (intersectional stigma, structural racism) that affect virologic suppression (Aim 1). After recruitment milestones are met, we will perform a nested randomized clinical trial to test a multi-component intervention to improve virologic suppression, adherence, positive affect, and stimulant use among sexual minority men living with HIV who use stimulants (n=300). The intervention, known as reSTART, will combine an evidence-based positive affect intervention delivered through a smartphone app and use of urine point-of- care testing to perform adherence self-monitoring, with motivational messages to improve or maintain adherence delivered via the reSTART app (Aim 2). In Aim 3 of the proposal, we will assess the impact of reSTART on incremental cost per person on virologic suppression and optimal antiretroviral therapy adherence measured via hair tenofovir levels. By this high-impact study’s end, we will have identified multi-level determinants of the treatment continuum among digitally-recruited sexual minority men living with HIV, including among those who use stimulants; and the impact of a multi-component reSTART mHealth intervention using novel point-of-care adherence self- monitoring on HIV virologic suppression, adherence, and cost among a key underserved population.

项目摘要/摘要与男人发生性关系的性少数族裔男性/男人，包括那些人，包括那些人，包括患有艾滋病毒的生活可能会损害美国通过干扰艾滋病毒护理来结束艾滋病毒流行目标感染艾滋病毒的性少数族裔男性的订婚，依从性和病毒学抑制。著名的艾滋病毒感染的性少数族裔男性，多层次障碍干扰艾滋病毒病毒学抑制，特别是在使用兴奋剂的人中。我们将以数字方式招募至少1,000名患有艾滋病毒的性少数民族男性，其中至少40％将确定由于黑人/非裔美国人和至少70％将具有积极的兴奋剂用途，以识别多层次的决定师在艾滋病毒感染艾滋病毒的少数族裔男性中，艾滋病毒护理参与，依从性和病毒性抑制，使用和不使用兴奋剂。在社会生态模型的指导下，我们将研究网络因素（HIV）状态，兴奋剂使用），地理空间决定剂（背景刺激使用率，EHE区域）和其他影响病毒学抑制的结构因素（交叉污名，结构种族主义）（AIM 1）。后满足招聘里程碑，我们将执行嵌套的随机临床试验来测试多组分干预性以改善性抑制，依从性，积极影响和刺激性使用兴奋剂的艾滋病毒的少数民族男性（n = 300）。干预措施称为重新启动，将结合通过智能手机应用程序提供的基于证据的积极影响干预措施，并使用尿液点护理测试以执行依从性自我监控，并提供励志信息以改进或维护通过重新启动应用程序（AIM 2）交付的依从性。在提案的目标3中，我们将评估在病毒学抑制和最佳抗逆转录病毒疗法上，以每人的增量成本重新启动通过头发替诺福韦水平测量。通过这项高影响力的研究，我们将确定治疗连续体的多层次决定者在数字化的性少数族裔男性中，包括使用兴奋剂的人；和多组分使用新颖的护理依从性自我重新启动MHealth干预的影响在关键服务不足的人群中监测HIV病毒学抑制，依从性和成本。