PrEP for Black MSM: Community-Based Ethnography and Clinic-Based Treatment

黑人 MSM 的 PrEP：基于社区的民族志和基于临床的治疗

• 批准号: 8409889
• 负责人: PAUL W COLSON
• 金额: $ 63.81万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-21 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8409889
• 关键词: AIDS prevention; AIDS/HIV problem; Adherence; Affect; Anti-Retroviral Agents; Behavior Therapy; Behavioral; Caring; Clinic; Clinical; Clinical Research; Clinical Trials; Communities; Couples; Development; Effectiveness; Elements; Epidemic; Ethnography; Face; Generations; HIV; HIV Infections; HIV diagnosis; Health Knowledge, Attitudes, Practice; Health Personnel; Health Priorities; Health system; Infection; Intervention; Interview; Investigation; Latino; Life; Link; Maps; Measures; Methods; New York City; Oral; Participant; Perception; Pharmaceutical Preparations; Play; Population; Population Group; Populations at Risk; Prevalence; Prevention; Preventive Intervention; Primary Health Care; Prophylactic treatment; Randomized; Randomized Controlled Trials; Research; Research Design; Research Methodology; Research Personnel; Risk; Risk Behaviors; Role; Sampling; Services; Shapes; Social Concepts; Social Environment; Social Network; Surveys; Testing; United States; Woman; Work; arm; base; clinical care; compare effectiveness; contextual factors; design; evidence base; experience; high risk; informant; innovation; men; men who have sex with men; next generation; pill; population based; preclinical study; prevent; primary care setting; scale up; sex; sex risk; sexual relationship; social; social science research; success; tool; transmission process; uptake

DESCRIPTION (provided by applicant): In the United States, men who have sex with men (MSM) comprise the group most severely affected by the HIV epidemic: 61% of all new infections in 2009 occurred in this population. Black MSM experience an even more disproportionate burden of infections, with prevalence of 28% in contrast to 16% in White, non- Latino MSM. HIV-infected Black MSM are also more likely than White MSM to receive an HIV diagnosis at their first testing experience, suggesting that they are less likely than other group to benefit from HIV prevention and control services. Clearly, the reduction of HIV-related disparities in Black MSM is a national health priority, essential to the success of efforts to contol and prevent HIV/AIDS as articulated in the National HIV/AIDS Strategy. Pre-Exposure Prophylaxis (PrEP), which has been shown to reduce acquisition among MSM, could play a critical role in the next generation of combination prevention interventions. Before PrEP is scaled up on a national level, however, critical questions must be answered regarding both the community-level factors that will shape uptake of and adherence to PrEP among Black MSM and the optimal clinical package for delivering PrEP in a way that is both scalable and effective. There is, moreover, a relationship between the broader social needs and perceptions of Black MSM and that clinical care package, and so we propose a multi-method study that incorporates community-based ethnography and an intervention in a community primary care clinic. The community-based ethnographic research will consist of institutional mapping, key informant interviews, ethnographic interviews with a systematic ethnographic sample, participant observation, and analysis of material culture. Drawing on the concepts of social risk, life projects, and social networks, we will explore the structural and cultural factors that shape men's sexual relationships, health systems engagement, and knowledge attitudes and practices related to HIV prevention in general and PrEP in particular. Findings from the ethnographic research will provide urgently needed information regarding community-contextual factors relevant to designing combination prevention interventions that include PrEP, and will lay the groundwork for the randomized controlled trial for PrEP for Black MSM in a community-based clinic. The clinic-based research will randomize eligible HIV- negative Black MSM to an enhanced versus standard PrEP package of care and compare their effectiveness on adherence with PrEP and reduction in sexual risk behaviors. The RCT will generate critical information regarding the acceptability of PrEP for Black MSM in a community clinical context, adherence to PrEP under non-experimental conditions, health providers' experiences with PrEP, and the impact of PrEP on sexual risk practices. PUBLIC HEALTH RELEVANCE: Black Men who have sex with men (MSM) have among the highest rates of new HIV infections of any group in the United States, and developing effective HIV prevention interventions that work with this group is a critical element of the National HIV/AIDS Strategy. We propose to carry out community-based research that will explore factors relevant to how Black MSM might engage with PrEP, and then to conduct a study in a community primary care clinic to compare two packages for providing PrEP. Together these efforts will provide critical information for building more effective HIV prevention interventions or this at-risk population.

描述（由申请人提供）：在美国，男男性行为者（MSM）是受艾滋病毒流行影响最严重的群体：2009年所有新感染病例中有61%发生在这一人群中。黑人男男性接触者经历了更不成比例的感染负担，患病率为28%，而白色非拉丁裔男男性接触者的患病率为16%。感染艾滋病毒的黑人男男性行为者也比白色男男性行为者更有可能在第一次检测时得到艾滋病毒诊断，这表明他们比其他群体更不可能从艾滋病毒预防和控制服务中受益。显然，减少黑人男男性行为者中与艾滋病毒有关的差距是国家卫生优先事项，对于《国家艾滋病毒/艾滋病战略》所述控制和预防艾滋病毒/艾滋病的努力取得成功至关重要。暴露前预防（PrEP）已被证明可以减少MSM人群的感染，在下一代联合预防干预措施中可能发挥关键作用。然而，在PrEP在国家一级扩大之前，必须回答关于社区一级因素的关键问题，这些因素将影响黑人MSM对PrEP的吸收和坚持，以及以可扩展和有效的方式提供PrEP的最佳临床方案。 还有，此外，更广泛的社会需求和黑人男男性接触者的看法和临床护理包之间的关系，所以我们提出了一个多方法的研究，结合社区为基础的民族志和社区初级保健诊所的干预。 以社区为基础的民族志研究将包括机构绘图，关键的知情人访谈，民族志访谈与系统的民族志样本，参与者观察和物质文化的分析。利用社会风险、生活计划和社交网络的概念，我们将探讨塑造男性社会的结构和文化因素。 性关系、卫生系统的参与以及与艾滋病毒预防有关的知识、态度和做法，特别是PrEP。民族志研究的结果将提供与设计包括PrEP在内的组合预防干预措施相关的社区背景因素的迫切需要的信息，并将为在社区诊所中进行的黑人MSM PrEP随机对照试验奠定基础。这项基于临床的研究将把符合条件的艾滋病毒阴性黑人男男性行为者随机分配到增强型与标准型PrEP护理包中，并比较他们在坚持PrEP和减少性风险行为方面的有效性。随机对照试验将产生关于PrEP在社区临床环境中对黑人MSM的可接受性，在非实验条件下坚持PrEP，卫生提供者的PrEP经验以及PrEP对性风险实践的影响的关键信息。 公共卫生关系：与男性发生性关系的黑人男性（MSM）是美国任何群体中艾滋病毒新感染率最高的群体之一，制定有效的艾滋病毒预防干预措施是国家艾滋病毒/艾滋病战略的关键要素。我们建议开展以社区为基础的研究，将探讨相关因素如何黑男男性接触者可能与PrEP，然后进行一项研究，在社区初级保健诊所比较两个包提供PrEP. Together这些努力将提供关键信息，为建立更有效的艾滋病毒预防干预措施或这一高危人群。