Effectiveness of combination HIV preventive interventions for young Thai MSM

泰国年轻男男性接触者联合艾滋病毒预防干预措施的有效性

• 批准号: 9300829
• 负责人: Christopher C. Beyrer
• 金额: $ 62.24万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9300829
• 关键词: AIDS prevention; Acute; Address; Adherence; Asia; Awareness; Car Phone; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Cohort Studies; Collaborations; Communities; Cost Analysis; Cost Measures; Cost Savings; Counseling; Data; Effectiveness; Enrollment; Epidemic; Foundations; Goals; HIV; HIV Infections; HIV Seropositivity; Health Promotion; Human immunodeficiency virus test; Incidence; Individual; Infection; Infection prevention; Intervention; LGBT Health; Lubricants; Methods; Oral; Participant; Persons; Phase; Population; Prevention; Prevention strategy; Preventive Intervention; Procedures; Process; Prostitution; Qualitative Methods; Recording of previous events; Reporting; Research; Research Design; Rights; Risk; Risk Reduction; Scoring Method; Services; Structural Models; Tenofovir; Testing; Thailand; Time; Treatment Cost; Universities; Work; aged; base; behavior change; community consultation; condoms; cost; cost effective; cost effectiveness; density; design; disability-adjusted life years; discount; effectiveness trial; empowerment; emtricitabine; experience; high risk; male; male sex worker; member; men; men who have sex with men; open label; pre-exposure prophylaxis; public health relevance; sex; sexual risk taking; truvada; uptake; young man; young men who have sex with men

 DESCRIPTION (provided by applicant): This Thai-US collaborative application seeks to develop and conduct a non-randomized effectiveness and cost-effectiveness study of a multi-level combination HIV preventive intervention with and without daily oral Tenofovir/Emtricitabine (Truvada) pre-exposure prophylaxis (PrEP) with mobile phone-based SMS adherence support among young men who have sex with men (YMSM) in Bangkok, Thailand. The current epidemic of HIV among Thai YMSM (men aged 18-26) is marked by high HIV incidence (5-12/100py) despite current prevention and treatment efforts, and rates are highest among the youngest men, aged 18-21, and among the subset of YMSM who sell sex. The proposed combination intervention will include individual level components: frequent HIV testing, risk reduction counseling, condom and lubricant distribution, and behavior change counseling; community awareness and mobilization; and an open label offer of PrEP with SMS (FrontlineSMS) adherence support. Participants will include Thai YMSM engaged in sex work or with a history of recent (in the previous 12 months) selling sex. The proposed study will be conducted by Johns Hopkins, Mahidol, and Emory Universities; The Thai MOPH-US CDC Collaboration (TUC) and its Silom Community Clinic @ Trop Med (SCC); and community partners including SWING, a sex worker empowerment and health promotion group; Rainbow Sky, an LGBT health and rights group; and APCOM, the Asia-Pacific Community of MSM. This group combines unique expertise, access, and experience in working with YMSM in this hyper-epidemic context. The study will include a formative phase using qualitative and community engagement methods to refine the intervention; a pilot; the open label intervention assessing effectiveness of combination interventions with and without PrEP and SMS adherence support with an HIV infection endpoint; and a costing and cost-effectiveness assessment which will measure the costs associated with the combined intervention, the number of infections averted through PrEP use, discounted treatment costs save, and assess whether the intervention packages are cost- saving, cost effective, or not cost-effective. The effectiveness study has been powered on the comparison of person time on PrEP versus not on PrEP and will employ propensity score methods to reduce the potential bias inherent in the self-selection design. In all the study proposes to enroll 1240 YMSM, 620 who choose PrEP and 620 who do not choose PrEP.

 描述（由申请人提供）：该泰国-美国合作申请旨在开发和实施一项非随机有效性和成本效益研究，在泰国曼谷男男性行为者（YMSM）中开展多水平联合HIV预防干预，联合和不联合每日口服替诺福韦/恩曲他滨（Truvada）暴露前预防（PrEP）和基于移动的的SMS依从性支持。泰国青年男男性行为者（18-26岁男子）中目前艾滋病毒流行的特点是艾滋病毒发病率很高（5-12/100 py），尽管目前正在进行预防和治疗工作，而且在18-21岁的最年轻男子和从事性交易的青年男男性行为者中发病率最高。拟议的联合干预将包括个人层面的组成部分：频繁的艾滋病毒检测，降低风险咨询，避孕套和润滑剂的分发，行为改变咨询;社区意识和动员;以及开放标签提供的PrEP与SMS（FrontlineSMS）依从性支持。参与者将包括从事性工作或最近（在过去12个月内）有卖淫史的泰国YMSM。这项拟议中的研究将由约翰霍普金斯大学、玛希敦大学和埃默里大学;泰国卫生部-美国疾病预防控制中心合作组织（TUC）及其是隆社区诊所@ Trop Med（SCC）;以及社区合作伙伴，包括SWING，一个性工作者赋权和健康促进组织;彩虹天空，一个LGBT健康和权利组织;和APCOM，亚太MSM社区。该小组结合了独特的专业知识，访问和经验，在这种高度流行的背景下与YMSM合作。该研究将包括一个形成阶段，使用定性和社区参与方法来完善干预措施;试点;开放标签干预措施，评估有和没有PrEP和SMS依从性支持的联合干预措施与艾滋病毒感染终点的有效性;以及成本和成本效益评估，该评估将衡量与联合干预相关的成本，通过PrEP使用避免的感染数量，贴现治疗成本节省，并评估干预方案是否节省成本，成本效益，或不符合成本效益。有效性研究基于使用PrEP与不使用PrEP的人的时间比较，并将采用倾向评分方法来减少自我选择设计中固有的潜在偏倚。在所有 该研究计划招募1240名YMSM，其中620名选择PrEP，620名不选择PrEP。