Peer Navigation to Improve Engagement in Care for HIV-Positive MSM in South Africa

 描述（由申请人提供）：在南非，艾滋病毒阳性的男男性行为者（MSM）没有最佳地参与艾滋病毒护理。在姆普马兰加省Ehlanzeni农村地区的MSM社区，患病率估计为23%，发病率接近每100人年30人，不到10%的艾滋病毒阳性MSM参与护理或接受ART。迫切需要有针对性的干预措施来改善艾滋病毒阳性男男性行为者对护理的参与，但目前还没有可以大规模采取的经证明有效的干预措施。患者导航策略，特别是同伴导航（PN），已在多种情况下实施，并针对多个人群，并显示出改善艾滋病毒连续护理结果的希望，包括参与，保留，ART依从性和病毒抑制。为了解决南非男男性接触者对这种干预的迫切需求，我们建议进行研究，以适应、手册化和实施南非男男性接触者PN干预模式（目标1），评估Ehlanzeni区100名HIV阳性男男性接触者PN干预的可行性和可接受性（目标2），并为未来的全面干预做准备。PN干预的多中心疗效试验，通过比较100名MSM与50名接受标准转诊临床护理的HIV阳性MSM的连续护理结局（目标3）。我们将分两个阶段实现这些目标：1）系统的、定性的干预适应性研究，2）随机分配到PN或标准护理条件的MSM的试点随机对照试验。我们将利用NIAID赞助的Mpumalanga男性研究（R 01 AI 089292，Lane），NIMH赞助的HIV自我检测研究（R21 MH 103038，Lippman）和PEPFAR赞助的普通人群客户中的同伴导航试验（当前对照试验NCT 02417233）期间开发的发现和基础设施来进行拟议的研究。我们假设PN干预对于HIV阳性MSM是可行的和可接受的;与标准治疗相比，随机接受PN的患者在参与、保留、依从性和病毒抑制方面的改善更大;可行和可接受的PN干预可以与其他预防方法相结合，最终显示出持续的社区水平的影响，降低这一高负担关键人群发病率所需的护理指标。

 DESCRIPTION (provided by applicant): HIV-positive men who have sex with men (MSM) in South Africa are not optimally engaged in HIV care. In MSM communities in rural Ehlanzeni district of Mpumalanga province, where prevalence is estimated at 23% and incidence at nearly 30 per 100 person-years, less than 10% of HIV-positive MSM are engaged in care or taking ART. Closing the substantial gap between treatment need and uptake among MSM is critical as South Africa implements 2015 guidelines recommending ART at CD4<500. Targeted intervention approaches to improve HIV-positive MSM's engagement in care are urgently needed, yet there are presently no interventions of proven efficacy that can be taken to scale. Patient navigation strategies, particularly peer navigation (PN), have been implemented in multiple contexts and tailored to multiple populations, and show promise in improving HIV continuum of care outcomes, including engagement, retention, ART adherence, and viral suppression. To address the urgent need for such an intervention for South African MSM, we propose research to adapt, manualize, and implement a PN intervention model for South African MSM (Aim 1), to assess the feasibility and acceptability of the PN intervention with 100 HIV-positive MSM in Ehlanzeni district (Aim 2), and to prepare for a future full-scale, multi-site efficacy trial of the PN intervention by comparing continuum of care outcomes of those 100 MSM to 50 HIV-positive MSM receiving standard referrals to clinical care (Aim 3). We will achieve these aims in two phases: 1) systematic, qualitative intervention adaptation research, and 2) a pilot randomized controlled trial of MSM randomly assigned to PN or standard-of-care conditions. We will leverage findings and infrastructure developed during the NIAID-sponsored Mpumalanga Men's Study (R01AI089292, Lane), an NIMH-sponsored HIV Self-Testing Study (R21MH103038, Lippman), and a PEPFAR-sponsored trial of peer navigation among general population clients (Current Controlled Trials NCT02417233) to carry out the proposed research. We hypothesize that the PN intervention will be feasible and acceptable to HIV-positive MSM; that those randomized to PN will show greater improvements in engagement, retention, adherence, and viral suppression compared to those in the standard-of-care; and that a feasible and acceptable PN intervention may be combined with other prevention approaches that will ultimately show the community-level effects across the continuum-of-care indicators necessary to reduce incidence in this high-burden key population.