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: 10558858
• 负责人: Joseph Daniels
• 金额: $ 9.39万
• 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/10558858
• 关键词: 18 year old; AIDS prevention; Africa South of the Sahara; African; Ally; Behavioral; Cellular Phone; Clinical Trials; Communication; Communities; Community Outreach; Couples; Data; Diagnosis; Disclosure; Discrimination; Education; Evidence based intervention; Fright; Grant; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; High Risk Woman; Home; Human immunodeficiency virus test; Incidence; Individual; Intervention; Interview; Knowledge; Length; Linguistics; Measures; Mediator of activation protein; Methods; Names; Outcome; Outcome Measure; Parents; Participant; Patient Recruitments; Perception; Persons; Phase; Pilot Projects; Play; Prevalence; Prevention; Qualitative Research; Research; Research Activity; Risk; Risk Assessment; Role; Safe Sex; Safety; Sampling; Self Efficacy; Sexual Partners; South Africa; South African; Stress; Testing; 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; experience; feasibility testing; human centered design; improved; interest; intervention delivery; intimate behavior; mHealth; men; men who have sex with men; movie; pilot test; pre-exposure prophylaxis; preference; recruit; skills; social stigma; syndemic; transgender women; transmission process; treatment adherence; uptake; usability; video chat; violence victimization; 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%， 艾滋病毒阳性的男男性行为者最好坚持抗逆转录病毒治疗（ART）。这些结果与 在撒哈拉以南非洲地区，只有四分之一的MSM受到病毒抑制， ART依从性欠佳。此外，至少有三分之一的新艾滋病毒感染的男男性行为者发生在小学， 与主要伴侣进行无安全套肛交的比例较高，艾滋病毒感染率较低， 有伴侣的男人之间的测试，以及通过无避孕套的性行为创造信任和亲密的愿望。MSM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， 表明，关于病毒抑制的不准确知识正在减少不可检测的影响。 不可传递（U=U）策略。为了改善男男性行为者的艾滋病毒结果，我们的初步工作确定了 对干预的偏好，包括智能手机与视频聊天和基于小组的干预集中 在艾滋病毒的压力，披露和治疗管理，而在关系的技能建设。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），以适应和试点测试来评估 南非东开普省的男男性接触的可行性。这种干预提高了艾滋病毒披露风险的自我效能 评估和安全性行为。在我们的适应中，我们将整合以下附加组件： 教育、艾滋病毒披露管理规划和通过视频会议进行的家庭ART管理 (VC)提供人力资源和VC签到，以支持依从性行为改变。HR将被命名为MPowered 通过适应和干预的赋权目标反映地方声音。 在第一个目标中，我们将调整和评估MR的可用性，整合ADAPT-IIT阶段和以人为本 设计将成立一个社区咨询委员会来指导增强组件、语言的集成 VC MR会话和组登记的注意事项、偏好和mHealth技术注意事项。 在第二个目标中，我们将试点测试MR的可行性及其对行为和生物医学的初步影响。 结果测量，以18岁或以上的艾滋病毒阳性男男性行为者为样本， 非最佳抗逆转录病毒疗法依从者，代表一系列关系长度，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、ART依从性和病毒载量的介质的初步影响。这些 结果将为更大规模的R 01临床试验提供信息，以衡量MR的疗效，从而在ART中获得收益 南非男男性行为者的合作伙伴的依从性，一个在艾滋病毒规划和研究中严重忽视的群体。