Tailoring Healthy Relationships to Improve HIV Treatment Outcomes for MSM in Eastern Cape, South Africa

调整健康的关系以改善南非东开普省男同性恋者的艾滋病毒治疗结果

• 批准号: 10372235
• 负责人: Joseph Daniels
• 金额: $ 16.97万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-15 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10372235
• 关键词: 18 year old; AIDS prevention; Address; African; Attention; Behavioral; Caring; Cellular Phone; Clinical Trials; Communities; Couples; Diagnosis; Disclosure; Education; Evidence based intervention; Fright; Goals; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; Home; Human immunodeficiency virus test; Individual; Intervention; Knowledge; Length; Linguistics; Link; Measures; Mediator of activation protein; Names; Outcome; Outcome Measure; Participant; Partner Communications; Phase; Play; Population; Prevalence; Prevention; Qualitative Research; Randomized Controlled Trials; Research; Research Activity; Risk; Risk Assessment; Role; Safe Sex; Safety; Sampling; Self Efficacy; Sexual Partners; South Africa; South African; Stress; Testing; Time; Treatment outcome; Trust; Unsafe Sex; Videoconferencing; Viral; Viral Load result; Voice; Work; antiretroviral therapy; arm; base; behavioral adherence; condomless anal sex; cost; design; dosage; empowerment; evidence base; feasibility testing; high risk men; human centered design; improved; interest; intimate behavior; mHealth; male; men; men who have sex with men; movie; patient engagement; pilot test; pre-exposure prophylaxis; preference; programs; recruit; skills; transmission process; treatment adherence; uptake; usability; video chat; willingness

PROJECT ABSTRACT There is 18.1% HIV prevalence for men who have sex with men (MSM) in South Africa and less than 10% of HIV-positive MSM are optimally adherent to antiretroviral treatment (ART). These outcomes are consistent with findings for MSM across sub-Saharan African settings where only a quarter are virally suppressed due to suboptimal ART adherence. Further, at least one-third of new HIV infections for MSM occur within primary partnerships, driven by higher rates of condomless anal intercourse with main partners, lower levels of HIV testing among partnered men, and the desire to create trust and intimacy through condomless sex. MSM often lack skills in communicating and managing their HIV treatment and prevention with existing and new partners. Studies indicate that uptake of HIV prevention is lower within established relationships and emerging evidence indicates that inaccurate knowledge about viral suppression is reducing the impact of Undetectable = Untransmittable (U=U) strategies. To improve HIV outcomes for partnered MSM, our preliminary work identified preferences for an intervention to include smartphones with video-chat and group-based interventions focused on skill-building in HIV stress, disclosure and treatment management while in relationships. Given these findings, we identified one evidence-based intervention—Healthy Relationships (HR)—to adapt and pilot-test to assess feasibility for MSM in Eastern Cape, South Africa. This intervention improves self-efficacy in HIV disclosure risk assessment and safe sex practices. In our adaptation, we will integrate additional components of: U=U education, HIV disclosure management planning, and ART management in the home with video-conference (VC) delivery of HR, and VC check-in’s to support adherence behavioral changes. HR will be named MPowered in Relationships (MR) to reflect local voices through adaptation and the empowerment objective of intervention. In the first aim, we will adapt and assess usability of MR, integrating ADAPT-IIT phases and Human Centered Design. A community advisory board will be established to guide integration of Enhanced Components, linguistic considerations, preferences, and mHealth technical considerations for VC MR sessions and Group Check-In’s. In the second aim, we will pilot-test the feasibility of MR and its preliminary impact on behavioral and biomedical outcome measures, with a community-based sample of HIV-positive MSM who are 18 years of age or older, sub-optimally ART adherent, represent a range of relationship lengths, have HIV-negative or unknown status partner, and live in Eastern Cape. We will determine feasibility (feasibility, acceptability, willingness, safety, cost), and the preliminary impact on mediators of HIV prevention and disclosure, ART adherence, and viral load. These outcomes will inform a larger R01 clinical trial powered to measure the efficacy of MR to create gains in ART adherence for partnered MSM in South Africa, a group critically overlooked in HIV programming and research.

项目摘要 在南非，男男性行为者(MSM)的艾滋病毒感染率为18.1%，而不到10%的人 HIV阳性的男男性同性恋者最好坚持抗逆转录病毒治疗(ART)。这些结果与 对撒哈拉以南非洲地区男男性接触者的研究结果，那里只有四分之一的人因 不是最理想的艺术坚持。此外，至少三分之一的男男性同性恋者新感染艾滋病毒发生在初选阶段 与主要伴侣的无套肛交比率较高，艾滋病毒水平较低，推动了伙伴关系 在有伴侣的男性中进行测试，以及通过无避孕套的性行为建立信任和亲密关系的愿望。男男性接触者经常 缺乏与现有和新伙伴沟通和管理艾滋病毒治疗和预防的技能。 研究表明，在已建立的关系和新出现的证据中，艾滋病毒预防的接受率较低 表明关于病毒抑制的不准确知识正在减少无法检测到的 不可传递(U=U)策略。为了改善结伴男男性接触者的HIV结局，我们的初步工作确定了 倾向于将智能手机与视频聊天和基于小组的干预集中在一起进行干预 关于艾滋病毒压力、披露和恋爱期间治疗管理方面的技能建设。鉴于这些发现， 我们确定了一种基于证据的干预措施--健康关系(HR)--以适应并试行测试以评估 南非东开普省男男性接触者的可行性。这种干预提高了艾滋病病毒暴露风险的自我效能 评估和安全性行为实践。在我们的调整中，我们将集成：U=U的其他组件 通过视频会议在家中进行教育、艾滋病毒披露管理规划和艺术管理 (VC)交付HR和VC签到，以支持遵守行为更改。HR将被命名为mPowed 在关系中(MR)，通过适应和干预的赋权目标来反映当地的声音。 在第一个目标中，我们将适应和评估MR的可用性，结合Adapt-IIT阶段和以人为本 设计。将建立一个社区咨询委员会，以指导加强的组成部分、语言和语言的整合 VC MR会话和团体签到的注意事项、首选项和mHealth技术注意事项。 在第二个目标中，我们将初步测试MR的可行性及其对行为和生物医学的初步影响 结果衡量标准，以社区为基础的18岁或以上艾滋病毒阳性男男性行为者样本， 次佳的是抗逆转录病毒药物的追随者，代表一系列的关系长度，具有HIV阴性或未知状态 合伙人，住在东开普省。我们将确定可行性(可行性、可接受性、意愿、安全性、成本)， 以及对艾滋病毒预防和披露、抗逆转录病毒治疗依从性和病毒载量的媒介的初步影响。这些 结果将为一项更大的R01临床试验提供信息，该试验旨在衡量MR的有效性，以在ART中创造收益 南非男男性接触者的坚持，这是一个在艾滋病毒规划和研究中被严重忽视的群体。