Expedited Partner Therapy and STI Control for MSM in Peru

秘鲁 MSM 的快速伴侣治疗和性传播感染控制

• 批准号: 8153915
• 负责人: Thomas J. Coates
• 金额: $ 17.91万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8153915
• 关键词: Address; Anatomic Sites; Antibiotic Therapy; Behavior Therapy; Behavioral; California; Centers for Disease Control and Prevention (U.S.); Chlamydia; Chlamydia Infections; Clinical Trials; Clinical effectiveness; Coitus; Complex; Counseling; Coupling; Data; Decision Making; Development; Diagnosis; Dimensions; Environment; Epidemic; Epidemiology; Europe; Evaluation; Focus Groups; Foundations; Future; Gender; Gonorrhea; Guidelines; HIV; HIV Infections; HIV/STD; Heterosexuals; Incidence; Individual; Infection; Interdisciplinary Study; Intervention; Interview; Low Prevalence; Methods; Nature; Network-based; Notification; Outcome; Outcome Measure; Participant; Partner Notification; Patients; Pattern; Peru; Pilot Projects; Population; Population Study; Practice Management; Prevalence; Preventive Intervention; Process; Protocols documentation; Randomized; Randomized Clinical Trials; Recommendation; Recurrence; Reporting; Risk Factors; Series; Sexual Partners; Social Environment; Structure; Syphilis; Theoretical model; Therapeutic Intervention; Urethra; Visit; burden of illness; design; evidence base; experience; follow-up; genital herpes; instrument; male; men; men who have sex with men; rectal; research study; social; transmission process

DESCRIPTION (provided by applicant): Expedited Partner Therapy (EPT) has been shown to reduce rates of persistent or recurrent gonorrhea and chlamydia infection in heterosexual patients, but has not been evaluated for use among men who have sex with men (MSM). CDC guidelines support the use of EPT for partner management with heterosexual patients, but note the absence of evidence necessary to make an equivalent recommendation for the use of EPT with MSM. Randomized clinical trials to assess the impact of EPT on partner notification, treatment, and STI re- infection among MSM are critical to the development of evidence-based partner management guidelines. Our recent data from urban Peru has identified prevalences of rectal and pharyngeal gonorrhea and chlamydia ranging from 5-20%. The elevated burden of disease among MSM in Peru suggests that frequent transmission of undiagnosed gonorrhea and chlamydia through MSM sexual networks may be a factor contributing to the persistently high incidence of HIV infection among MSM in the region. We propose a pilot evaluation of the effect of EPT on partner notification and treatment among MSM in Peru diagnosed with gonorrhea or chlamydia at any anatomic site. Specific Aim 1: To explore the social norms and structural factors influencing partner notification and treatment among MSM in Peru. Specific Aim 2: To determine the effect of EPT on anticipated and actual partner notification among MSM diagnosed with gonorrhea or chlamydia infection. Specific Aim 3: To develop preliminary data on rates of gonococcal and chlamydial re-infection among MSM randomized to receive EPT compared with standard partner notification counseling. As a theoretical model, EPT integrates behavioral, social, and biomedical approaches to HIV/STI control in a comprehensive prevention intervention. Our proposed exploration of the social and behavioral dimensions of partner notification and treatment will provide a methodological structure for understanding the influence of EPT on behavioral decision-making processes, interpersonal factors that influence partner notification, and network patterns of STI transmission within MSM populations in Peru. Our biomedical assessment of gonorrhea and chlamydia re-infection will provide preliminary data to support the development of a definitive clinical trial of EPT for HIV/STI control in MSM populations. Practical issues including an evaluation of methods to assess notification and treatment rates, determination of the composition of participants' sexual networks (including the number of unlocatable partners in participant networks), and an overview of logistical issues involved in implementing and assessing an EPT intervention in the local environment, will all contribute to the development and refinement of a future trial of EPT for HIV/STI control with MSM. PUBLIC HEALTH RELEVANCE: STI co-infection is an important risk factor for HIV transmission during sexual intercourse, particularly among men who have sex with men (MSM). Expedited Partner Therapy (EPT) has been shown to be effective in controlling the spread of STIs in heterosexual partnerships, but has not been evaluated among MSM. We propose a pilot study of the impact of EPT on partner notification and treatment among MSM in Peru diagnosed with gonorrhea or chlamydia.

描述（由申请人提供）：快速伴侣治疗 (EPT) 已被证明可以降低异性恋患者持续或复发性淋病和衣原体感染率，但尚未在男男性行为者 (MSM) 中使用进行评估。 CDC 指南支持使用 EPT 对异性恋患者进行伴侣管理，但指出缺乏必要的证据来提出对 MSM 使用 EPT 的同等建议。评估 EPT 对 MSM 中性伴侣通知、治疗和性传播感染再感染影响的随机临床试验对于制定基于证据的性伴侣管理指南至关重要。 我们最近从秘鲁城市获取的数据已确定直肠和咽部淋病和衣原体的患病率在 5-20% 之间。秘鲁男男性行为者疾病负担的增加表明，未确诊的淋病和衣原体通过男男性行为者性网络的频繁传播可能是导致该地区男男性行为者艾滋病毒感染率持续居高的一个因素。我们建议对秘鲁任何解剖部位诊断为淋病或衣原体的 MSM 中 EPT 对伴侣通知和治疗的影响进行试点评估。具体目标 1：探讨影响秘鲁 MSM 伴侣通知和治疗的社会规范和结构因素。具体目标 2：确定 EPT 对诊断为淋病或衣原体感染的 MSM 的预期和实际伴侣通知的影响。具体目标 3：与标准伴侣通知咨询相比，开发随机接受 EPT 的 MSM 中淋球菌和衣原体再感染率的初步数据。 作为一种理论模型，EPT 将行为、社会和生物医学方法整合到综合预防干预中来控制 HIV/STI。我们提出的对伴侣通知和治疗的社会和行为维度的探索将为理解 EPT 对行为决策过程的影响、影响伴侣通知的人际因素以及秘鲁 MSM 人群中 STI 传播的网络模式提供一个方法结构。我们对淋病和衣原体再感染的生物医学评估将提供初步数据，以支持在 MSM 人群中开展 EPT 控制 HIV/STI 的明确临床试验。实际问题包括评估通知率和治疗率的方法、确定参与者性网络的构成（包括参与者网络中无法定位的性伴侣的数量）以及对在当地环境中实施和评估 EPT 干预措施所涉及的后勤问题的概述，所有这些都将有助于未来通过 MSM 控制 HIV/STI 的 EPT 试验的开发和完善。 公共卫生相关性：性传播感染合并感染是性交过程中艾滋病毒传播的一个重要危险因素，特别是在男男性行为者 (MSM) 中。快速伴侣治疗 (EPT) 已被证明可以有效控制异性伴侣中性传播感染的传播，但尚未在 MSM 中进行评估。我们提议开展一项试点研究，探讨 EPT 对秘鲁诊断患有淋病或衣原体的 MSM 的伴侣通知和治疗的影响。