Understanding PrEP Implementation Among Club Drug Using Men Who Have Sex With Men

简介(申请人提供)：背景。根据疾病控制和预防中心的数据，2006年美国发现了超过55000例新的艾滋病毒感染病例，其中50%是报告与其他男性(MSM)发生性关系的男性(CDC，2008年)。药物使用，特别是冰毒和其他俱乐部药物(如摇头丸、羟基丁酸等)与男男性接触者中的HIV性行为和HIV感染密切相关。使用抗逆转录病毒药物替诺福韦恩曲他滨作为暴露前预防(PrEP)是一种新的生物医学艾滋病毒预防策略，有助于减少艾滋病毒的传播。最近在未感染艾滋病毒的男性和女性中进行的试验表明，PrEP是安全和耐受性良好的，来自2499名MSM中每日口服PrEP的多国随机对照试验的数据最近公布，显示艾滋病毒感染显著减少(Grant，Lama等人)。2010)。尽管针头交换计划等减少伤害的策略已被证明可以减少注射吸毒者(IDU)中的艾滋病毒感染，但尚不清楚PrEP将如何在使用俱乐部药物并从事HIV性危险行为的MSM中使用。项目概述。我们建议对报告最近俱乐部吸毒和同时发生性行为风险(最近3个月)的未感染艾滋病毒的MSM进行定性访谈(阶段1)和更大的定量评估(阶段2)，以更好地了解在这一高危群体实施PrEP的促进者和障碍。所有参与者将从波士顿地区的酒吧、夜总会和舞蹈俱乐部招募，这些酒吧、夜总会和舞蹈俱乐部被认为吸引了同性恋和双性恋男性以及发生俱乐部吸毒的其他男男性接触者。第一阶段定性访谈将在40名未感染HIV的MSM中进行，以了解有HIV风险的不同俱乐部吸毒水平的MSM对PrEP的接受性、使用意向和感知能力的潜在因素。我们将快速分析这些数据，以便为更大的定量调查评估(阶段2)提供信息并加强问题。在第二阶段，将使用日期-时间-地点抽样从大波士顿地区的各种场所(酒吧、夜总会、舞蹈俱乐部)随机招募375名MSM(考虑到他们的招募地点到他们的面对面评估访问之间20%的自然减员，在第二阶段评估中总共产生300人)。在这300名男男性接触者中，50%将符合DSM-IV关于滥用/依赖某一俱乐部药物的标准，另外50%将是那些报告最近使用过俱乐部药物，但不符合滥用/依赖标准的人(即不经常吸食)。吸取的经验教训将为制定干预措施以加强在男男性接触者这一高危人群中采用和利用PrEP提供重要的见解。 公共卫生相关性：过去3个月的数据显示，有证据支持暴露前预防(PrEP)作为减少高危男男性接触者(MSM)艾滋病毒传播的一种方法。与普通人群和不吸毒的男男性接触者相比，使用毒品促进性行为的MSM是一个亚群体，已经被证明通过性危险行为感染艾滋病毒的风险增加。因此，至关重要的是，我们必须了解在感染艾滋病毒风险较大的这一MSM群体中实施PrEP的促进者和障碍。吸取的经验教训将应用于干预措施的制定，以加强这一高危群体对PrEP等生物医学预防措施的接受和利用。

DESCRIPTION (provided by applicant): Background. According to the Centers for Disease Control and Prevention, there were over 55,000 new HIV infections identified in the United States in 2006, and >50% were among men who report having sex with other men (MSM) (CDC, 2008). Substance use, in particular crystal methamphetamine and other club drugs (e.g., ecstasy, GHB, etc.) are highly associated with HIV sexual risk behavior and HIV infection among MSM. The use of the antiretrovirals tenofovir emtricitabine as pre-exposure prophylaxis (PrEP) is a novel biomedical HIV prevention strategy to help decrease HIV spread. Recent trials in HIV-uninfected men and women have demonstrated that PrEP is safe and well-tolerated, and data from a multinational randomized controlled trial of daily oral PrEP among 2,499 MSM were recently released, and show a significant decrease in HIV acquisition (Grant, Lama et al. 2010). Although harm reduction strategies such as needle exchange programs have been shown to decrease HIV infection among injection drug users (IDUs), it is unclear how PrEP will be utilized among MSM who use club drugs and engage in HIV sexual risk behavior. Overview of project. We propose to conduct qualitative interviews (phase 1) and a larger quantitative assessment (phase 2) among HIV-uninfected MSM who report recent club drug use and concurrent sexual risk (in the last 3 months) to gain a better understanding of the facilitators and barriers to PrEP implementation in this high risk group. All participants will be recruited from bars, nightclubs, and dance clubs in the Boston area that are known to attract gay and bisexual men and other MSM where club drug use is occurring. The phase 1 qualitative interviews will be conducted among 40 HIV-uninfected MSM to understand the potential factors surrounding PrEP acceptability, intent to use, and perceived ability to take PrEP among MSM with varied levels of club drug use who are at risk for HIV. We will rapidly analyze these data to inform and strengthen questions for the larger quantitative survey assessment (phase 2). In phase 2, Date-Time-Venue sampling will be used to recruit a random sample of 375 MSM (allowing for a 20% attrition from their recruitment venue to their in person assessment visit, yielding 300 total for the phase 2 assessment) from a variety of venues (bars, night clubs, dance clubs) in the greater Boston area. Of these 300 MSM, 50% will meet DSM-IV criteria for abuse/dependence of a given club drug and the other 50% will be those who have reported recent club drug use, but do not meet criteria for abuse/dependence (i.e., infrequent users). The lessons learned will provide key insights in the development of interventions to enhance PrEP adoption and utilization in this high-risk subpopulation of MSM. PUBLIC HEALTH RELEVANCE: Data over the last 3 months has shown evidence supporting a role for pre-exposure prophylaxis (PrEP) as a method to decrease HIV transmission in high-risk men who have sex with men (MSM). MSM who use drugs to enhance sexual activity is a subpopulation that has been shown to have an increased risk of HIV infection through sexual risk behavior compared to the general population, and MSM who do not use drugs. It is therefore essential that we understand the facilitators and barriers to PrEP implementation in this subpopulation of MSM who are at greater risk for HIV. The lessons learned will be applied to intervention development to enhance acceptance and utilization of biomedical preventions such as PrEP among this high- risk group.