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4年补充项目将把功能磁共振成像(FMRI)纳入 最近资助的暴露前预防(PrEP)的多阶段优化策略(MOST)试验- 对新登记的阿片类药物注射吸毒者(PWID)的重点干预 使用障碍(Moud)治疗(R01DA055534；Copenhaver，PI)。这样做的科学前提是 补充剂直接建立在家长拨款中总结的证据上-认知障碍是 在PWID中很常见，如果不正确的话，会破坏以PrEP为重点的艾滋病毒预防成果 安排好了。神经成像组件将包括与认知功能障碍特别相关的任务 以及PrEP和Moud结果以及在接触PrEP教育期间专门获得的数据 视频和在休息状态下。基于我们之前在与父母相同的Moud诊所进行的工作 试验，我们预计~80%的参加家长试验的个人将有兴趣并有资格 功能磁共振扫描。因此，我们预计在4年内扫描大约200人，包括 目的：(1)明确进入PrEP的个体认知障碍的基于大脑的机制- 有针对性的干预。在fMRI扫描期间，参与者将完成特定的认知功能任务 与父母试验中正在测试的补偿性干预成分的相关性(即 认知/执行功能、注意力、记忆和信息处理)。数据将使用以下工具进行分析 先进的、基于网络的方法(例如，独立分量分析)，可提供前所未有的 PWID患者认知功能障碍的神经过程综合表征 Moud和PrEP，以及(2)识别返回危险行为的预测性神经标记物(即PrEP和PrEP 穆德结果)。我们将使用可解释的、基于连接性的方法、基于连接组的预测性方法 建模(CPM)，以确定PrEP和Moud结果的预测性神经标志物。建议数 补充工作将提供对临床个体差异因素的机械性洞察 有多项高危行为(如无套性行为、共用针头)的个人 Moud，是开发最优化的、基于生物的预防和 为抗击目前的阿片类药物流行所作的干预努力。