Expedited Partner Therapy and STI Control for MSM in Peru

描述（由申请人提供）：加速伴侣治疗（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的发生率，但尚未评估其在男男性行为者（MSM）中的使用。CDC指南支持使用EPT对异性恋患者进行伴侣管理，但注意到缺乏必要的证据来对MSM使用EPT提出同等建议。评估EPT对MSM中伴侣通知、治疗和STI再感染的影响的随机临床试验对于制定循证伴侣管理指南至关重要。 我们最近从秘鲁城市获得的数据表明，直肠和咽部淋病和衣原体的患病率在5- 20%之间。秘鲁男男性行为者的疾病负担增加表明，通过男男性行为者性网络频繁传播未确诊的淋病和衣原体可能是该区域男男性行为者艾滋病毒感染率持续高企的一个因素。我们提出了一个试点评估EPT的合作伙伴之间的通知和治疗秘鲁的男男性接触者诊断为淋病或衣原体在任何解剖部位的效果。具体目标1：探讨影响秘鲁男男性行为者伴侣通知和治疗的社会规范和结构性因素。具体目标二：目的：探讨EPT对诊断为淋病或衣原体感染的男男性行为者预期和实际伴侣告知的影响。具体目标3：建立随机接受EPT与标准伴侣通知咨询的MSM淋球菌和衣原体再感染率的初步数据。 作为一种理论模式，EPT将行为、社会和生物医学方法整合到艾滋病毒/性传播感染控制的综合预防干预中。我们提出的探索合作伙伴的通知和治疗的社会和行为层面将提供一个方法论的结构，了解EPT对行为决策过程的影响，人际因素，影响合作伙伴的通知，和网络模式的STI传播的男男性接触人群在秘鲁。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的确定性临床试验。实际问题，包括评估通报率和治疗率的方法，确定参与者性网络的组成（包括参与者网络中无法确定位置的伙伴的数量），以及在当地环境中实施和评估EPT干预措施所涉及的后勤问题概述，所有这些都将有助于发展和完善未来的试验EPT艾滋病毒/性病控制与男男性接触。

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.