PrEP for HIV Prevention in MSM: Mixed-Methods Study of Behavior & Message Framing

描述（由申请人提供）：这个K01研究和培训奖推进了将行为和生物医学策略整合在男男性行为者（MSM）中预防艾滋病毒的长期目标。拟议的培训将使PI能够发展在这一领域从事独立研究所需的技能。该研究计划的重点是抗逆转录病毒暴露前预防（PrEP）的行为影响，这是一种新兴的艾滋病毒预防生物医学策略。预计PrEP在预防新感染方面部分有效，基于早期研究数据的模型表明PrEP可能降低男男性接触者的艾滋病毒发病率。然而，PrEP的实际效果将取决于用户的行为，而这些行为的不确定性阻碍了计划扩大规模的努力。我们关注两种行为：PrEP启动——开始使用PrEP；风险补偿——使用者可能会因为相信自己不受感染而承担更多与艾滋病毒相关的风险。探索性研究表明，对PrEP有效性的期望会影响每一种行为，但我们缺乏MSM中这两种行为的概念模型。还有人担心，这些行为可能会受到描述PrEP疗效的不同策略的影响。我们解决了这些差距，重点关注罗得岛普罗维登斯的男男性行为者。第一阶段将使用焦点小组和个人定性访谈来探索可能影响PrEP启动和风险补偿的社会心理和背景因素。第二阶段将利用这些发现和之前在生物医学艾滋病毒预防方面的工作，开发每一种行为的概念模型，以及评估使用PrEP的意愿、对风险补偿的态度和对PrEP疗效的期望的定量结果。第三阶段将依靠信息框架原则，对两种与男男性接触者沟通预防措施的策略进行随机试验，一种使用基于成功的信息（强调预防措施预防艾滋病毒的可能性），另一种使用基于失败的信息（使用相同的有效性估计，但强调预防措施失败的可能性）。我们假设，收到成功信息的参与者更愿意使用PrEP，但对疗效有更高的期望，对风险补偿的态度也更宽容。我们的发现可以推广到其他部分有效的艾滋病毒预防策略，如疫苗和包皮环切。未来的研究计划包括制定行为干预措施，以优化MSM中PrEP的使用。为了使PI能够实现这一长期研究议程，她将与经验丰富的导师合作，建立四个专业领域：(1)生物医学艾滋病毒预防的行为影响方面的专业知识，包括PrEP、暴露后预防、疫苗、杀微生物剂和包皮环切术之间的联系；(2)卫生传播和信息框架方面的专门知识；(3)在混合方法研究中进行定性研究的技能；(4)在混合方法研究中进行定量研究的技能，包括制定结果测量、实施试验和统计分析试验数据。该K01解决了艾滋病预防科学的一个关键优先事项，它将为PI在该领域的独立研究生涯做好充分准备。

DESCRIPTION (provided by applicant): This K01 research and training award advances the long-term goal of integrating behavioral and biomedical strategies for preventing HIV among men who have sex with men (MSM). The proposed training will enable the PI to develop the skills needed for an independent research career in this field. The research plan focuses on the behavioral impacts of antiretroviral pre-exposure prophylaxis (PrEP), an emerging biomedical strategy for HIV prevention. PrEP is anticipated to be partially efficacious for preventing new infections, and models based on early study data suggest that PrEP may reduce HIV incidence among MSM. However, PrEP's actual effectiveness will depend on users' behaviors, and uncertainty about these behaviors hampers efforts to plan for scale-up. We focus on two behaviors: PrEP initiation - starting to use PrEP; and risk compensation - the possibility that users will take more HIV-related risks on the belief that they are protected from infection. Exploratory research suggests that expectations of PrEP efficacy will influence each behavior, but we lack conceptual models of either behavior among MSM. There is also concern about how these behaviors might be influenced by different strategies for describing PrEP's efficacy. We address these gaps, focusing on MSM in Providence, RI. Phase 1 will use focus groups and individual qualitative interviews to explore psychosocial and contextual factors likely to influence PrEP initiation and risk compensation. Phase 2 will draw on these findings and prior work in biomedical HIV prevention to develop a conceptual model of each behavior, and quantitative outcomes assessing willingness to use PrEP, attitudes about risk compensation, and expectations of PrEP's efficacy. Phase 3 will rely on message framing principles to conduct a randomized trial of two strategies for communicating with MSM about PrEP, one using success-based messages (emphasizing PrEP's likelihood of preventing HIV), and one using failure-based messages (using identical estimates of efficacy, but emphasizing PrEP's likelihood of failure). We hypothesize that participants receiving success-based messages will be more willing to use PrEP, but will have higher expectations of efficacy and more permissive attitudes toward risk compensation. Our findings may generalize to other partially efficacious HIV prevention strategies, such as vaccines and circumcision. Future research plans include developing behavioral interventions to optimize PrEP use among MSM. To enable the PI to pursue this long-term research agenda, she will work with experienced mentors to build four areas of expertise: (1) expertise in the behavioral impacts of biomedical HIV prevention, including links among PrEP, post-exposure prophylaxis, vaccines, microbicides, and circumcision; (2) expertise in health communications and message framing; (3) skills for conducting qualitative research in mixed-methods studies; and (4) skills for conducting quantitative research in mixed-methods studies, including developing outcome measures, implementing trials, and statistically analyzing trial data. This K01 addresses a key priority in HIV prevention science, and it will fully prepare the PI for an independent research career in the field. PUBLIC HEALTH RELEVANCE: Antiretroviral pre-exposure prophylaxis (PrEP) - providing antiretroviral medications to HIV-negative people before they engage in HIV risk behaviors - is a promising new biomedical option being developed for HIV prevention, but uncertainty about PrEP's behavioral impacts impedes preparations for using it as a public health strategy. We will address this uncertainty through formative research on two behaviors that will influence how well PrEP works in practice: PrEP initiation (whether people decide to use PrEP medications) and risk compensation (the possibility that people will increase their HIV risk behaviors once they are using PrEP). The outcomes of our study will enable the development of behavioral interventions to encourage effective PrEP use among men who have sex with men, who are a national priority for HIV prevention.