Acceptability, feasibility, and preliminary impact of a web-based, HIV prevention toolkit with cisgender male couples in Lima, Peru

1概要/摘要 2 3秘鲁利马的性少数男性受艾滋病毒的影响不成比例， 4名男子在恋爱期间感染艾滋病毒（即，cisgender男性夫妇）。联合国儿童基金会成员进行的研究 5个调查小组发现，顺性别男性夫妇使用循证艾滋病毒/性传播感染预防战略（例如， 6抗逆转录病毒疗法、预防性接触、常规艾滋病毒/性传播感染检测、使用避孕套）对于可靠地预防感染和/或 7艾滋病毒和其他性传播疾病的传播，因为他们目前从事危险的性行为。到目前为止，没有夫妇- 在利马或秘鲁的其他地方，有8项基于艾滋病毒/性传播感染的预防干预措施。的首要目标 9.拟议的三年期项目旨在帮助填补秘鲁艾滋病毒/性传播感染预防服务方面的这一重大空白。首先，我们 10进行了一个混合方法试点项目，以评估PI的理论基础的电子健康的可接受性， 在利马对42对顺性别男性夫妇进行了11次基于夫妇的艾滋病毒/性传播感染预防工具包干预（14次一致 12例HIV阴性，16例不一致，12例一致HIV阳性）。90%的夫妇报告说， 13干预，最喜欢的协议建设者活动。夫妇们告诉我们，他们想要更多的信息， 14关于艾滋病毒治疗作为预防（PrEP，ART，TasP/U = U）以及如何加强和管理自己和 15个家庭关系（文化背景）。他们还希望干预措施可以在不同的网站上访问- 16个连接设备。其他研究结果显示，只有33%-50%的夫妇包括基于证据的艾滋病毒/性传播感染 17个预防策略。为了帮助改善夫妇对循证医学的接受和持续使用， 18预防策略，我们的解决方案是将电子算法集成到协议生成器活动中， 19为他们提供量身定制的建议，与他们参与性行为相一致， 20关系简介方法：通过提出的R34，我们的下一步是应用剩余的阶段， 21 ADAPT-ITT模型以人为本的设计元素，以适应我们的夫妇为基础的干预。我们将 22然后进行为期6个月的试点RCT与等待名单控制，以评估可行性，可接受性和初步 23适应性干预对60对顺性别男性夫妇的影响，按他们的二人艾滋病毒血清状态分层， 24项成果：a）制定并遵守量身定制的风险降低计划和协议; B）关系 25功能（例如，c）使用循证艾滋病毒预防战略; d）艾滋病毒/性传播感染发病率 26、时间我们提出的方法是严格的科学前提，作为混合方法和试点RCT， 27等待名单控制将用于实现我们的具体目标。我们的项目也是及时和实用的关键 28个利益相关者购买，表明我们的提案具有很高的公共卫生意义。我们的发现将揭示 29减少夫妇艾滋病毒/性传播感染风险的经调整的工具包干预措施的可行性、可接受性和初步影响 30通过在一段时间内通过制定和坚持循证艾滋病毒预防战略持续使用这些战略 31个定制的协议和降低风险的计划。我们的下一步将是应用这些发现（例如，R01）测试 第32章为了效率我们的项目与NOT-MH-20 - 019和NOT-MH-20 - 020有关。

1 SUMMARY / ABSTRACT 2 3 Sexual minority men in Lima, Peru are disproportionately impacted by HIV, and a substantial proportion of these 4 men acquire HIV while in a relationship (i.e., cisgender male couples). Studies conducted by members of the 5 investigative team found that cisgender male couples’ use of evidence-based HIV/STI prevention strategies (e.g., 6 ART, PrEP, routine HIV/STI testing, condom use) are sub-optimal to reliably prevent acquisition and/or 7 transmission of HIV and other STIs given their current engagement in sexual risk behaviors. To date, no couples- 8 based HIV/STI prevention interventions are available in Lima or elsewhere in Peru. The overarching goal of the 9 proposed 3-year project is to help fill this critical gap in Peru’s HIV/STI prevention services. To start, we 10 conducted a mixed method pilot project to assess the acceptability of the PI’s theoretically-grounded eHealth, 11 couples-based HIV/STI prevention toolkit intervention with 42 cisgender male couples in Lima (14 concordant 12 HIV-negative, 16 discordant, 12 concordant HIV-positive). 90% of couples reported high acceptability of the 13 intervention, and liked the agreement builder activity the most. Couples told us they wanted more information 14 about HIV treatment as prevention (PrEP, ART, TasP/U=U) and how to strengthen and manage their own and 15 familial relationships (cultural context). They also wanted the intervention to be accessible on different web- 16 connected devices. Additional findings revealed only 33%-50% of couples included evidence-based HIV/STI 17 prevention strategies in their agreement. To help improve couples’ uptake and continued use of evidence-based 18 prevention strategies, our solution is to integrate an electronic algorithm into the agreement builder activity to 19 provide them with tailored recommendations that align with their engagement in sexual behaviors and 20 relationship profile. Methods: Via the proposed R34, our next steps are to apply the remaining stages of the 21 ADAPT-ITT model with elements of human-centered design to adapt our couples-based intervention. We will 22 then conduct a 6-month pilot RCT with a waitlist control to assess the feasibility, acceptability, and preliminary 23 impact of the adapted intervention with 60 cisgender male couples, stratified by their dyad HIV serostatus, on 24 outcomes of: a) formation and adherence to a tailored risk-reduction plan and agreement; b) relationship 25 functioning (e.g., communication); c) use of evidence-based HIV prevention strategies; and d) HIV/STI incidence 26 over time. Our proposed approach is rigorous with scientific premise as mixed methods and a pilot RCT with 27 a waitlist control will be used to achieve our Specific Aims. Our project is also timely and practical with key 28 stakeholder buy-in, suggesting the high Public Health significance of our proposal. Our findings will reveal the 29 feasibility, acceptability and preliminary impact of the adapted toolkit intervention to reduce couples’ HIV/STI risk 30 via sustained use of evidence-based HIV prevention strategies over time through their formation and adherence 31 to a tailored agreement and risk-reduction plan. Our next step will be to apply these findings (e.g., R01) to test 32 the intervention for efficacy. Our project is of interest to NOT-MH-20-019 and NOT-MH-20-020.