TRUST

描述（由申请人提供）：全球艾滋病协调员办公室（OGAC）联合预防艾滋病毒技术指南为男同性恋者及其伴侣定义了一个全面的艾滋病毒预防服务项目。当前的提案“基于网络的MSM在可信社区场所的HCT、护理、治疗和预防服务的招募”（TRUST）进行了一项运营研究前瞻性队列研究，评估了将OGAC项目的每个要素纳入综合服务模型的干预措施。TRUST的中心假设是，通过网络招募扩大尼日利亚男男性行为者的参与，将客户与社区信任场所提供的综合预防和全面艾滋病毒和医疗服务联系起来，实现可衡量的行为改变和持久的高质量临床结果。TRUST的三个目标是：1)评估受访者驱动抽样（RDS）作为一种招聘工具，定义HCT和服务参与的障碍，量化测试和治疗的可接受性；2)衡量信任干预对预防结果的影响；3)定义最优服务交付模式。为了实现这些目标，TRUST采用RDS，这是一种数学定义的同行驱动链推荐方法，从阿布贾和拉各斯的男男性行为者社区招募1200名客户，在以社区为基础的男男性行为者信任场所提供综合服务。对HCT和接受治疗的障碍进行了量化。先前由调查小组在其他低收入环境中开发的经过验证的行为和创新自我网络风险评估工具被用于衡量尼日利亚男同性恋者的行为模式和性行为，并监测信托参与对行为和生物（事件艾滋病毒和性传播感染）结果的影响。特别关注的是网络关系在影响行为方面的作用，以及信任在理解和加强有利的同伴介导行为规范方面的潜力。考虑到结构化的艾滋病毒预防干预措施随着时间的推移而失去效力的倾向，TRUST模式将密集的联合预防干预措施与MSM社区“拥有”场所正在进行的综合临床服务提供联系起来，是一个潜在地加强持续和持久的行为改变的平台，这种改变是由“有凝聚力的”性网络成员相互加强的。通过客观的临床（如治疗反应、依从性）、提供者（临床能力）、地点（同伴“任务转移”的影响）和客户（满意度）分析来评估临床服务提供的优化。信托倡议的产出是：1)扩大了对尼日利亚男男性行为者社会和性网络范围的了解；2)风险实践的驱动因素及其修正；3)艾滋病毒和性传播感染的治疗和联合预防对减少高危行为和性行为的影响；4)对非传统场所提供的艾滋病毒和医疗服务的质量进行客观评估。这些信息将共同指导建立p级信托的最佳做法，作为总统防治艾滋病紧急救援计划提供服务的模式，具有巨大影响的潜力。

DESCRIPTION (provided by applicant): The Office of Global AIDS Coordinator (OGAC) Technical Guidance on Combination HIV Prevention defines a comprehensive HIV-prevention services program for MSM and their partners. The current proposal, "Network-Based Recruitment of MSM into HCT, Care, Treatment and Prevention Services at Trusted Community-based Venues" (TRUST) conducts an operations research prospective cohort study that evaluates an intervention that engages each element of the OGAC program in an integrated service model. The central hypothesis of TRUST is that Network-based recruitment to expand engagement of Nigerian MSM that links clients to combination prevention and comprehensive HIV and medical services delivered at community-trusted venues achieves measurable behavioral change, and durable high quality clinical outcomes. The three aims of TRUST are: 1) To evaluate Respondent Driven Sampling (RDS) as a recruitment tool, define barriers to HCT and service engagement and quantify acceptability of test and treat; 2) Measure the impact of the TRUST intervention on prevention outcomes; 3) Define the optimal service delivery model. To achieve these aims TRUST engages RDS, a mathematically defined peer-driven chain referral method to recruit 1200 clients from the MSM communities of Abuja and Lagos into a comprehensive service delivery at MSM community-based trusted venues. Barriers to HCT and treatment uptake are quantified. Validated behavioral and innovative ego network risk assessment tools previously developed by the investigative team in other low income settings are employed to measure patterns of behavior and sexual practice among MSM in Nigeria, and monitor impact of TRUST engagement on behavioral and biological (incident HIV and STI) outcomes. A particular focus is the role of network relationships in influencing behaviors and the potential of TRUST to understand and strengthen favorable peer-mediated behavioral norms. Given the propensity of structured HIV prevention interventions to lose effectiveness over time, the TRUST model, linking intensive combination prevention interventions to ongoing comprehensive clinical service delivery in MSM community "owned" venues is a platform that potentially reinforces sustained and lasting behavioral change that is mutually reinforced by members of "cohesive" sexual networks. Optimization of clinical service delivery is evaluated through objective clinical (e.g. treatment response, adherence), provider (clinical competence), site (impact of peer "task shifting") and client (satisfaction) analyses. Th outputs of the TRUST initiative are: 1) expanded understanding of the extent of MSM social and sexual networks in Nigeria; 2) the drivers of risk practices and their modification; 3) the impact f HIV and STI treatment and combination prevention to reduce high risk behaviors and sexual practices; 4) an objective assessment of the quality of HIV and medical services delivered in a nontraditional venue. Together this information will guide institution of best practices for scale p of TRUST as a PEPFAR model of service delivery with the potential for high impact. PUBLIC HEALTH RELEVANCE: The TRUST project, conducted in Nigeria which is second in the world for HIV, evaluates the impact of providing comprehensive and integrated prevention, treatment and care at community venues operated by local organizations supportive of men who have sex with men. The study investigates the impact on promoting safe sexual behaviors on the reduction of HIV infections and the impact of treatment to prevent AIDS. If the model is successful it can be expanded to support PEPFAR goals for prevention, care and treatment for marginalized populations, who continue to be significant drivers of the HIV/AIDS epidemic.