Optimizing evidence-based HIV prevention targeting people who inject drugs on PrEP

针对 PrEP 注射吸毒者优化基于证据的艾滋病毒预防

• 批准号: 10818897
• 负责人: MICHAEL COPENHAVER
• 金额: $ 39.53万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10818897
• 关键词: AIDS prevention; Adherence; Area; Attention; Behavior; Behavior Therapy; Behavioral; Behavioral Research; Brain; Cessation of life; Clinic; Clinical; Cognitive; Compensation; Complement; Data; Data Set; Development; Dorsal; Education; Educational process of instructing; Eligibility Determination; Enrollment; Epidemic; Exposure to; Functional Magnetic Resonance Imaging; Functional disorder; Funding; HIV risk; Impaired cognition; Individual; Individual Differences; Injecting drug user; Intervention; Learning; Literature; Methods; Motor; Needle Sharing; Network-based; Neurosciences; Outcome; Outcome Measure; Overdose; Parents; Participant; Patients; Pattern; Performance; Population; Prevention; Prevention approach; Process; Psyche structure; Public Health; Relapse; Reproducibility; Rest; Rewards; Risk Behaviors; Risk Reduction; Scanning; Sensory; Specific qualifier value; Testing; Training; United States; Unsafe Sex; Validation; Work; brain based; brain behavior; cognitive control; cognitive function; cognitive task; combat; connectome based predictive modeling; design; evidence base; executive function; functional MRI scan; high risk behavior; illicit opioid; independent component analysis; information processing; insight; interest; medication for opioid use disorder; memory process; mortality risk; multiphase optimization strategy; neural; neuroimaging; neuromechanism; opioid epidemic; opioid use; parent grant; patient population; pre-exposure prophylaxis; predicting response; preventive intervention; recruit; response; skills; treatment effect

The proposed 4-year Supplement project will incorporate functional magnetic resonance imaging (fMRI) into a recently funded multiphase optimization strategy (MOST) trial of a Pre-Exposure Prophylaxis (PrEP)- focused intervention for people who inject drugs (PWID) who are newly enrolled in medication for opioid use disorder (MOUD) treatment (R01DA055534; Copenhaver, PI). The scientific premise for this supplement builds directly on evidence summarized in the parent grant - that cognitive dysfunction is common among PWID and disrupts PrEP-focused HIV prevention outcomes, if not properly accommodated. The neuroimaging battery will include tasks of specific relevance to cognitive dysfunction and to PrEP and MOUD outcomes as well as data specifically acquired during exposure to PrEP educational videos and during resting state. Based on our prior work conducted in the same MOUD clinics as the parent trial, we anticipate that ~80% of individuals enrolled in the parent trial will be interested in and eligible for fMRI scanning. Thus, we anticipate scanning approximately 200 individuals over 4-years, with the following aims: (1) Specifying brain-based mechanisms of cognitive dysfunction among individuals entering PrEP- focused intervention. During fMRI scanning, participants will complete cognitive function tasks with specific relevance to compensatory intervention components being tested in the parent trial (i.e., validated tasks of cognitive/executive function,, attention, memory, and information processing). Data will be analyzed using advanced, network-based approaches (e.g., independent component analysis) to provide the first ever comprehensive characterization of neural processes subserving cognitive dysfunction among PWID entering MOUD and PrEP, and (2) Identifying predictive neuromarkers of return to risk behaviors (i.e., PrEP and MOUD outcomes). We will use an interpretable, connectivity-based approach, connectome-based predictive modeling (CPM), to identify predictive neuromarkers of PrEP and MOUD outcomes. The proposed supplemental work will provide mechanistic insight into clinical individual difference factors among individuals with multiple high-risk behaviors (e.g., condomless sex, needle sharing) among individuals in MOUD, and is an essential precursor to the development of optimized, biologically based, prevention and intervention efforts to combat the current opioid epidemic.

拟议的为期 4 年的补充项目将把功能性磁共振成像 (fMRI) 纳入 最近资助的暴露前预防 (PrEP) 多阶段优化策略 (MOST) 试验 - 针对新参加阿片类药物治疗的注射吸毒者 (PWID) 进行重点干预 使用障碍（MOUD）治疗（R01DA055534；Copenhaver，PI）。这样做的科学前提 补充直接建立在家长补助金中总结的证据之上 - 认知功能障碍是 在吸毒者中很常见，如果处理不当，会破坏以 PrEP 为重点的艾滋病毒预防结果 容纳。神经影像电池将包括与认知功能障碍特定相关的任务 PrEP 和 MOUD 结果以及在 PrEP 教育期间专门获得的数据 视频和休息状态下。基于我们之前在与家长相同的 MOUD 诊所进行的工作 试验中，我们预计参与家长试验的约 80% 的个人会对以下内容感兴趣并有资格参加 功能磁共振成像扫描。因此，我们预计在 4 年内对大约 200 人进行扫描，其中包括： 目标：(1) 明确进入 PrEP 的个体中基于大脑的认知功能障碍机制 集中干预。在功能磁共振成像扫描期间，参与者将完成特定的认知功能任务 与母试验中正在测试的补偿性干预成分的相关性（即，经过验证的任务 认知/执行功能、注意力、记忆力和信息处理）。数据将使用以下方式进行分析 先进的、基于网络的方法（例如独立成分分析）提供了有史以来第一个 促进吸毒者认知功能障碍的神经过程的综合特征 MOUD 和 PrEP，以及 (2) 识别风险行为回归的预测神经标志物（即 PrEP 和 PrEP） MOUD 结果）。我们将使用可解释的、基于连接的方法、基于连接组的预测 建模 (CPM)，以确定 PrEP 和 MOUD 结果的预测神经标志物。拟议的 补充工作将提供对临床个体差异因素的机制洞察 具有多种高危行为（例如无套性行为、共用针头）的个体 MOUD，是开发优化的、基于生物学的、预防和 打击当前阿片类药物流行的干预措施。