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

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）（疾病控制和预防中心，2008年）。物质使用，特别是晶体甲基苯丙胺和其他俱乐部毒品（例如摇头丸、g - b等）与男男性接触者的艾滋病毒性风险行为和艾滋病毒感染高度相关。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是安全且耐受性良好的，最近公布的一项在2499名男男性行为者中进行的每日口服PrEP的多国随机对照试验数据显示，艾滋病毒感染显著减少（Grant， Lama等人，2010年）。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吸毒者（IDUs）中的艾滋病毒感染，但目前尚不清楚如何在使用俱乐部毒品和从事艾滋病毒性风险行为的男同性恋者中使用PrEP。项目概述。我们建议在报告最近俱乐部吸毒和并发性风险（过去3个月）的未感染艾滋病毒的男男性接触者中进行定性访谈（第一阶段）和更大的定量评估（第二阶段），以更好地了解在这一高风险群体中实施PrEP的促进因素和障碍。所有参与者都将从波士顿地区的酒吧、夜总会和舞厅中招募，这些地方以吸引同性恋和双性恋男性以及其他男同性恋者而闻名，这些地方经常发生吸毒事件。第一阶段的定性访谈将对40名未感染艾滋病毒的男男性接触者进行，以了解影响PrEP可接受性、使用意图和感知能力的潜在因素，这些潜在因素是有感染艾滋病毒风险的不同程度的俱乐部吸毒男男性接触者。我们将迅速分析这些数据，为更大规模的定量调查评估（第二阶段）提供信息和加强问题。在第二阶段，日期-时间-地点抽样将用于从大波士顿地区的各种场所（酒吧，夜总会，舞厅）中随机招募375名男男性行为者（允许从他们的招聘地点到亲自评估访问的20%的减员，第二阶段评估总共300人）。在这300名男男性行为者中，50%将符合DSM-IV的滥用/依赖某一特定俱乐部药物的标准，另外50%将是那些报告最近有俱乐部药物使用，但不符合滥用/依赖标准的人（即不经常使用）。吸取的经验教训将为制定干预措施提供关键见解，以加强在这一高危男男性行为人群中采用和利用预防措施。

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.