Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants: Protocol for a Pilot Sequential Multiple Assignment Randomized Trial.
Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants: Protocol for a Pilot Sequential Multiple Assignment Randomized Trial.
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动机增强干预措施增加了使用兴奋剂的性少数族裔男性中暴露前预防的使用：用于飞行员顺序多次分配随机试验的方案。
DOI：
10.2196/48459
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发表时间：
2023-10-13
影响因子：
1.7
通讯作者：
Carrico, Adam W
中科院分区：
文献类型：
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作者：
Davis-Ewart, Leah;Grov, Christian;Verhagen, Rachel;Manuel, Jennifer;Viamonte, Michael;Dilworth, Samantha;O'Dell, Nicole;Valentin, Omar;Carr, Sidney;Cherenack, Emily;Henderson, Chelsea;Doblecki-Lewis, Susanne;Nahum-Shani, Inbal;Carrico, Adam W
虽然暴露前预防（PrEP）可以大大降低艾滋病毒的风险，但使用兴奋剂的性少数男性通常在参与PrEP临床服务方面遇到困难。动机访谈（MI）和应急管理（CM）减少了这一人群的药物使用和无套肛交（CAS），但这些动机增强干预措施需要修改，以促进PrEP护理连续体的参与。支持动机PrEP准备干预（PRISM）是一项连续多任务随机试验，旨在测试远程医疗MI和CM不同组合的可行性、可接受性和初步有效性。70名使用兴奋剂且目前未服用PrEP的顺性少数性取向男性通过社交网络应用程序招募了全国样本，以完成基线评估和邮寄艾滋病毒检测。HIV检测结果无反应的患者被随机分为两组：(1)2期MI干预，重点关注PrEP的使用（第1期）和同时使用兴奋剂或CAS（第2期）；或(2)CM干预，对医疗提供者提供的PrEP临床评估的书面证据给予财政奖励（50美元）并开具PrEP处方（50美元）。在3个月的随访评估中，报告他们没有服用PrEP处方的参与者被第二次随机分配到(1)切换到第二阶段干预（即MI+CM或CM+MI）或(2)继续仅进行评估。在6个月的随访中，对应答者和无应答者的结果进行重新评估。主要结果是6个月内服用PrEP处方的记录证据。自我报告的次要结果包括医疗提供者的PrEP临床评估、兴奋剂使用和CAS。对一组有反应者和无反应者进行定性退出访谈，以描述他们在MI和CM干预中的经历。棱镜计划的实施凸显了在接触使用兴奋剂的性少数男性以优化艾滋病毒预防工作方面的挑战。大约十分之一（104/1060）的合格参与者已经注册。在登记的104人中，87人（84%）完成了邮寄艾滋病毒检测。我们提供了5个初步艾滋病毒阳性结果，包括转介到确认检测的检测后咨询。从棱镜计划中吸取的教训强调了灵活的、以参与者为中心的方法对支持使用兴奋剂的性少数男性参与至关重要。利用远程保健平台提供激励增强干预措施也扩大了其对这一高度优先人群的覆盖范围和潜在的公共卫生影响。需要进一步的研究来确定远程医疗MI和CM在支持使用兴奋剂的性少数男性使用PrEP方面的有效性。ClinicalTrials.gov NCT04205487;https://clinicaltrials.gov/study/NCT04205487 derr1 - 10.2196/48459
Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex (CAS) in this population, but these motivational enhancement interventions require modifications to promote engagement along the PrEP care continuum. PrEP Readiness Interventions for Supporting Motivation (PRISM) is a pilot sequential multiple assignment randomized trial testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender sexual minority men who use stimulants that are not currently taking PrEP. A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with nonreactive HIV results were randomized to receive either (1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or CAS (session 2) or (2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider (US $50) and filling a PrEP prescription (US $50). At the 3-month follow-up assessment, participants who reported they had not filled a prescription for PrEP were randomized a second time to either (1) switch to a second-stage intervention (ie, MI+CM or CM+MI) or (2) continue with assessments only. Outcomes for both responders and nonresponders were reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription over 6 months. Self-reported secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and CAS. Qualitative exit interviews were conducted with a subgroup of responders and nonresponders to characterize their experiences with the MI and CM interventions. Implementation of PRISM underscores challenges in reaching sexual minority men who use stimulants to optimize HIV prevention efforts. Approximately 1 in 10 (104/1060) eligible participants have enrolled. Of the 104 who enrolled, 87 (84%) completed mail-in HIV testing. We delivered 5 preliminary HIV-positive results, including posttest counseling with referrals to confirmatory testing. Lessons learned from PRISM underscore the central importance of a flexible, participant-centered approach to support the engagement of sexual minority men who use stimulants. Leveraging telehealth platforms to deliver motivational enhancement interventions also expanded their reach and potential public health impact with this high-priority population. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in sexual minority men who use stimulants. ClinicalTrials.gov NCT04205487; https://clinicaltrials.gov/study/NCT04205487 DERR1-10.2196/48459
影响因子：
7.4
作者：
Khosropour CM;Johnson BA;Ricca AV;Sullivan PS
通讯作者：
Sullivan PS