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

了解俱乐部吸毒男男性行为者中 PrEP 的实施情况

• 批准号: 8208910
• 负责人: JENNIFER A MITTY
• 金额: $ 24.72万
• 依托单位: FENWAY COMMUNITY HEALTH CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-09 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8208910
• 关键词: AIDS prevention; Adoption; Affect; Alcohol or Other Drugs use; Amphetamines; Amyl Nitrite; Anal Sex; Area; Attention; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Biological; Biological Process; Bisexual; Boston; Centers for Disease Control and Prevention (U.S.); Collection; Complex; Crack Cocaine; DSM-IV; Dancing; Data; Data Analyses; Dependence; Diagnosis; Diagnostic; Disease; Drug Addiction; Drug usage; Economics; Enrollment; Gays; Gender; General Population; Goals; Grant; HIV; HIV Infections; HIV vaccine; Harm Reduction; Health; Incidence; Injecting drug user; Interview; Ketamine; Learning; Medical; Methamphetamine; Methods; Needle-Exchange Programs; Oral; Participant; Pattern; Persons; Phase; Population; Population Distributions; Prevention; Prevention approach; Prevention strategy; Prophylactic treatment; Randomized Controlled Trials; Recording of previous events; Recruitment Activity; Reporting; Research Personnel; Risk; Risk Reduction; Role; Sampling; Security; Services; Sex Behavior; Social Conditions; Social support; Stigmata; Substance abuse problem; Surveys; Tenofovir; Theoretical model; Time; United States; Violence; Visit; Woman; base; club drug; club drug abuse; condoms; disorder prevention; ecstasy; emtricitabine; experience; high risk; high risk men; innovation; insight; meetings; men; men who have sex with men; novel; population health; psychosocial; sex; sex risk; social; social inequality; social stigma; theories; therapy development; transmission process

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.

描述（由申请人提供）：背景。根据疾病控制和预防中心的数据，2006年美国有超过55，000例新的艾滋病毒感染，其中>50%是报告与其他男性发生性关系的男性（MSM）（CDC，2008）。药物使用，特别是甲基苯丙胺晶体和其他俱乐部药物（例如，摇头丸、GHB等）与男男性接触者的HIV危险性行为和HIV感染高度相关。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HIV预防策略，有助于减少HIV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是安全的，耐受性良好，最近发布了2，499名MSM每日口服PrEP的多国随机对照试验数据，并显示艾滋病毒感染显著减少（Grant，Lama等人，2010）。虽然减少伤害的策略，如针头交换计划已被证明可以减少注射毒品使用者（IDUs）中的艾滋病毒感染，但目前还不清楚如何在使用俱乐部药物和从事艾滋病毒性风险行为的MSM中使用PrEP。 项目概述。我们建议在未感染艾滋病毒的男男性行为者中进行定性访谈（第1阶段）和更大的定量评估（第2阶段），这些人报告最近的俱乐部药物使用和并发性风险（在过去3个月内），以更好地了解在这个高风险群体中实施PrEP的促进者和障碍。所有参与者都将从波士顿地区的酒吧、夜总会和舞蹈俱乐部招募，这些俱乐部吸引了同性恋和双性恋男子以及其他MSM，而这些俱乐部正在使用毒品。第一阶段定性访谈将在40名未感染艾滋病毒的男男性行为者中进行，以了解PrEP可接受性，使用意图和感知能力的潜在因素，以在具有不同水平的俱乐部药物使用的男男性行为者中采取PrEP。我们将快速分析这些数据，为更大规模的定量调查评估（第2阶段）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（允许从招募地点到亲自评估访问有20%的流失，第二阶段评估总共有300人）。在这300名MSM中，50%将符合DSM-IV关于滥用/依赖给定俱乐部药物的标准，另外50%将是那些报告最近使用俱乐部药物但不符合滥用/依赖标准的人（即，不常使用者）。所吸取的经验教训将为制定干预措施提供关键见解，以加强PrEP在MSM这一高风险亚群中的采用和利用。 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行为者（MSM）艾滋病毒传播的方法的作用。使用药物来增强性活动的MSM是一个亚群，与普通人群和不使用药物的MSM相比，已被证明通过性风险行为感染艾滋病毒的风险增加。因此，至关重要的是，我们要了解在艾滋病毒风险更大的男男性行为者亚群中实施PrEP的促进因素和障碍。所吸取的经验教训将应用于干预措施的制定，以提高这一高风险群体对PrEP等生物医学预防措施的接受和利用。