Optimizing HIV prevention for highly vulnerable methamphetamine-using sexual minority men

优化对高度脆弱的使用甲基苯丙胺的性少数男性的艾滋病毒预防

• 批准号: 10462053
• 负责人: Adam Wayne Carrico
• 金额: $ 195万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-08 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10462053
• 关键词: AIDS prevention; Address; Behavior; Biological; Caring; Clinical; Complex; Continuity of Patient Care; Effectiveness; Enrollment; Epidemic; Funding; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Human immunodeficiency virus test; Hybrids; Immune; Incentives; Incidence; Intervention; Laws; Methamphetamine; Methodology; Motivation; Participant; Peer Review; Pharmaceutical Preparations; Policies; Prevalence; Randomized Controlled Trials; Readiness; Reporting; Risk; Role; Sampling; Science; Social Network; Telephone; Testing; Toxicology; aged; biobehavior; chemokine; clinically relevant; cohort; comorbidity; comparative; contingency management; cytokine; density; design; digital; effectiveness testing; ethnic minority; evidence base; high risk; implementation science; men of color; methamphetamine use; methamphetamine user; motivational enhancement therapy; people of color; pre-exposure prophylaxis; primary outcome; prospective; psychologic; psychosocial; public health intervention; racial and ethnic; racial disparity; recruit; rectal; response; sexual minority; sexual minority group; sexual minority men; social; social determinants; social stigma; sound; success; syndemic; telehealth; transmission process; virtual

SUMMARY This LITE-2 (RFA-AI-21-018) initiative responds to a resurgent epidemic of methamphetamine (meth) use in sexual minority men (SMM), which is a primary driver of HIV incidence. The overarching goals are two-fold: 1) identify multi-level and bio-behavioral determinants of amplified HIV seroconversion risk in meth-using SMM; and 2) test the effectiveness of telehealth motivational enhancement interventions for optimizing entry or re-entry of SMM who use meth into the PrEP care continuum. Findings from our LITE-1 cohort (UG3/UH3 AI-133675, RFA-AI-16-031) and others provide compelling evidence that meth use is increasing, disproportionally impacts racial/ethnic minorities, and accounts for one-in-three new HIV infections in SMM. In response to LITE-2 (RFA- AI-21-018) we propose a multi-component initiative zeroing in on the “Where,” “How,” and “Why” of meth use and HIV risk. Where: What are the geospatial determinants of the association of meth use with HIV incidence? How: How can we support (re-)entry into the PrEP care continuum with this high priority population of SMM who use meth? Why: Does meth amplify biological risk of HIV by potentiating rectal immune dysregulation? Aim 1: Examine multi-level structural, psychological, and social determinants of amplified HIV seroconversion risk in SMM who use meth. The centerpiece of our LITE-2 initiative is a new prospective, bio-behavioral cohort with N=5,000 SMM (n=3,000 SMM who use meth, n=2,000 who do not). Participants will complete assessments over 36 months and provide biological samples for HIV testing, drug toxicology testing, rectal STIs, and rectal cytokines/chemokines. Our primary goal will be to investigate the role of geospatial determinants (e.g., background meth and HIV prevalence, urbanicity) and other structural determinants (e.g., structural stigma of sexual minorities as evidenced by policies/laws) in relation to the association of meth use with amplified HIV seroconversion risk. Aim 2: Test the comparative and combined effectiveness of telehealth motivational enhancement interventions for optimizing PrEP use. PrEP Readiness Interventions for Supporting Motivation (PRISM) is a hybrid type I, modified factorial randomized controlled trial (RCT) of telehealth CM that provides incentives for filling a PrEP prescription, and a 2-session telehealth MI intervention that we adapted with meth- using SMM (R34-DA046367, Carrico/Grov). PRISM will enroll 840 meth-using SMM who are not currently taking PrEP from the LITE-2 cohort (Aim 1) to examine the effectiveness of CM (n = 280), MI (n = 280), and MI+CM (n = 280) on the primary outcome – filling a PrEP prescription. Aim 3: Determine whether greater rectal immune dysregulation partially explains amplified risk of HIV seroconversion in SMM who use meth. Using a case-cohort design, we will compare HIV seroconverters (n=450) with matched seronegative controls (n=450) to examine the clinical relevance of meth-induced alterations in rectal cytokines with respect to HIV seroconversion. This LITE-2 initiative could have an exceptional impact by transforming HIV prevention with SMM.

概括 该Lite-2（RFA-AI-21-018）倡议对甲基苯丙胺（甲基苯丙胺）的救援流行作出反应 性少数人（SMM），这是艾滋病毒事件的主要驱动力。总体目标是两个方面： 1）确定在使用MET-SMM中放大HIV血清转化风险的多层次和生物行为决定者； 2）测试远程健康动机增强干预措施以优化进入或重新进入的有效性 使用甲基甲基苯丙胺的SMM。我们的Lite-1队列（UG3/UH3 AI-133675， RFA-AI-16-031）和其他人提供了令人信服的证据，表明甲基苯丙胺的使用正在增加，对 种族/族裔少数民族，占SMM中三分之一的新艾滋病毒感染。响应Lite-2（RFA-- AI-21-018）我们提出了一个多组分计划，以“ where”，“ how”和“为什么”的使用方式归零 和艾滋病毒风险。地点：使用甲基苯丙胺与艾滋病毒事件的地理空间决定者是什么？ 如何：我们如何支持（重新）进入PrEP Care连续体，而SMM的优先人口很高 使用冰毒？为什么：METH是否通过增强直肠免疫失调来扩大HIV的生物学风险？目标1： 检查放大HIV血清转化风险的多层结构，心理和社会认同 使用甲基苯丙胺的SMM。我们的Lite-2计划的核心是一个新的前瞻性生物行为队列 n = 5,000 SMM（n = 3,000 SMM，使用甲基苯丙胺，n = 2,000不使用）。参与者将完成评估 36个月，并提供用于HIV测试，药物毒理学测试，直肠性传播疾病和直肠的生物样品 细胞因子/趋化因子。我们的主要目标是调查地理空间决定者的作用（例如， 背景甲基苯丙胺和艾滋病毒流行，城市化）和其他结构决定者（例如，结构性污名 政策/法律所证明的与甲基甲基使用与放大艾滋病毒的关联有关的性少数群体 血清转化风险。目标2：测试远程医疗动机的比较和综合有效性 增强干预措施以优化准备使用。准备动机的准备就绪干预措施 （Prism）是Telehealth CM的I型混合I型，修改的阶乘随机对照试验（RCT） 填写准备处方的激励措施，以及我们适应Met的2条远程医疗MI干预措施 - 使用SMM（R34-DA046367，Carrico/Grov）。 Prism将注册840个使用Met的SMM，他们目前尚未服用 从LITE-2队列（目标1）进行准备，以检查CM（n = 280），Mi（n = 280）和Mi+cm的有效性 = 280）在主要结果上 - 填写准备处方。目标3：确定是否更大的直肠免疫 失调部分解释了使用METH的SMM中HIV血清转化的放大风险。使用案例船 设计，我们将比较HIV血清发电机（n = 450）与匹配的血清负格对照（n = 450） 与HIV血清转化相对于直肠细胞因子的MET诱导改变的临床相关性。这 LITE-2倡议可以通过使用SMM转化HIV预防，从而产生特殊的影响。