Understanding Viral Suppression for Newly Diagnosed HIV+ Men to Inform Implementation of TasP and U=U

了解新诊断的 HIV 男性的病毒抑制，为 TasP 和 U=U 的实施提供信息

基本信息

批准号：
10013526
负责人：
H. Jonathon Rendina
金额：
$ 94.69万
依托单位：
HUNTER COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-03-24 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10013526
关键词：
AIDS prevention Address Adherence Advocacy American Back Behavioral Biological Bisexual Blood Caring Centers for Disease Control and Prevention (U.S.)Clinical Clinical Trials Complement Consensus Continuity of Patient Care Couples Data Reporting Diagnosis Drops Early Intervention Empirical Research Enrollment Epidemic Epidemiology Event Financial compensation Focus Groups Future Gays General Population Goals Guidelines HIV HIV Infections HIV Seronegativity HIV Seropositivity HIV diagnosis Health Health Personnel Home environment Individual Infection Intervention Interview Lead Link Location Methods Minority Modeling Monitor Morbidity - disease rate Movement National Institute of Allergy and Infectious Disease National Institute of Child Health and Human Development National Institute of Mental Health Nature Newly Diagnosed Outcome Patient Self-Report Pattern Persons Phase Population Prevention Provider Public Health Qualitative Methods Research Resistance Risk Risk Factors Safety Sampling Sex Behavior Sexual Health Spottings Stress Structure Study models Surveys Time TimeLine Translating Treatment Efficacy United States National Institutes of Health Viral Viral Load result antiretroviral therapy base care providers cohort critical period design high risk improved improved outcome indexing insight men men who have sex with men men&apos s group mortality psychosocial recruit resilience routine practice scale up sexual HIV transmission sexual minority social success surveillance data theories therapy adherence therapy development transmission process uptake virtual

项目摘要

Project Summary Gay and bisexual men and other sexual minority men (SMM) in the U.S. are burdened by a high and disproportionate rate of HIV infection. Improving outcomes of the HIV Care Continuum through to maintaining viral load (VL) suppression is associated with a significant reduction in the sexual transmission of HIV and significantly better long-term health outcomes. However, little research provides insight into the preventable structural, psychosocial, and behavioral factors that influence durable VL suppression during early infection that can be used in developing effective early intervention strategies. Moreover, the successful implementation of TasP and U=U messaging is a necessary component of the strategy to end the HIV epidemic, but rigorous research is needed to address real-world implementation issues, including safety concerns and perceived barriers among key stakeholder populations. We aim to address these issues with two studies grounded in the Social Ecological Model (SEM) to simultaneously examine both VL suppression and implementation barriers surrounding U=U from multiple levels of influence. Specifically, Aim 1 of the study is to examine time to initial VL suppression and patterns in VL rebound to better understand the dynamic nature of VL suppression and use the SEM along with an intersectional minority stress framework to longitudinally investigate structural, psychosocial, and behavioral factors associated with VL suppression among SMM to better understand risk and resilience. Next, Aim 2 is to examine how adherence and perceived VL status are associated with objective VL status and whether concordance between perceived and actual VL suppression influences sexual risk compensation as captured by event-level sexual behaviors and STI infections. Finally, Aim 3 is designed to understand ongoing barriers to implementing U=U from the perspectives of the three populations critical to its successful implementation among SMM—namely, SMM living with HIV, HIV-negative SMM, and HIV care providers. To do so, Study 1 (Aims 1 and 2) will leverage two LITE cohorts to recruit 250 SMM newly diagnosed with HIV during the course of the studies—we will follow these men for two years immediately following diagnosis, collecting home-based dried blood spot for VL on a monthly basis to examine the dynamic nature of VL suppression. In addition to VL and self-reported data, the study will include objective indicators of adherence and care engagement as well as qualitative interviews. The goal of Study 1 will be to identify risk and resilience factors that influence VL suppression and can be used to guide future intervention development (Aim 1) while simultaneously addressing understudied safety concerns of implementing U=U with regard to unintended risks (Aim 2). In Study 2 (Aim 3), we will use focus groups conducted three times over five years to inform implementation of U=U messaging. Achieving the aims of the proposed study will provide key insights that will be critical for translating to or adapting interventions to enhance their potency and durability and improve the health of SMM living with HIV and curb new infections.

项目摘要在美国，同性恋和双性恋男人和其他性少数族裔（SMM）被高高的和艾滋病毒感染率不成比例。改善艾滋病毒护理连续体的结果来维护病毒载荷（VL）抑制与HIV的性传播显着减少长期健康结果明显更好。但是，很少的研究提供了对可预防的在早期感染期间影响耐用VL抑制的结构，社会心理和行为因素可以用于制定有效的早期干预策略。此外，成功实施 TASP和U = U消息传递是结束HIV流行的策略的必要组成部分需要研究来解决现实世界的实施问题，包括安全问题和感知到主要利益相关者人群之间的障碍。我们的目的是通过以下两项基于的研究来解决这些问题简单地检查VL抑制和实施障碍的社会生态模型（SEM）围绕u = u来自多个影响的u = u。具体而言，该研究的目标1是检查时间初始时间 VL反弹中的VL抑制和模式，以更好地了解VL抑制的动态性质和将SEM与少数族裔压力框架一起使用，以纵向研究结构性，与SMM之间的VL抑制相关的社会心理和行为因素，以更好地了解风险和弹性。接下来，目标2是检查依从性和感知的VL状态如何与客观的VL状态以及感知和实际VL抑制之间的一致性是否会影响性事件级的性行为和性传播感染所捕获的风险补偿。最后，AIM 3设计为从三个人群的角度了解实施U = U的持续障碍在SMM中成功实施，即SMM患有艾滋病毒，艾滋病毒阴性SMM和艾滋病毒护理提供者。为此，研究1（目标1和2）将利用两个Lite队列招募250 SMM 在研究过程中被诊断为艾滋病毒 - 我们将立即跟随这些男人诊断后，每月为VL收集基于家庭的干血点以检查动态 VL抑制的性质。除了VL和自我报告的数据外，该研究还将包括遵守和关怀参与以及定性访谈。研究1的目标是确定风险以及影响VL抑制的弹性因素，可用于指导未来的干预开发（AIM 1）同时解决实施U = U的安全性问题时意外风险（AIM 2）。在研究2（AIM 3）中，我们将使用五年内进行三次焦点小组告知U = U消息传递的实现。实现拟议研究的目标将提供关键的见解这对于转化或调整干预措施以提高其效力和耐用性和改善患有艾滋病毒的SMM的健康状况，并遏制新的感染。