TRUST

描述（由申请人提供）：全球艾滋病协调员办公室（OGAC）关于艾滋病毒联合预防的技术指南为男男性行为者及其伴侣定义了一个全面的艾滋病毒预防服务计划。目前的提案，“基于网络的招募MSM进入HCT，护理，治疗和预防服务在可信的社区为基础的场所”（TRUST）进行了一项前瞻性队列研究，评估干预，从事OGAC计划的每个元素在一个综合服务模型。TRUST的中心假设是，基于网络的招聘，以扩大尼日利亚男男性接触者的参与，将客户与社区信任场所提供的综合预防和全面的艾滋病毒和医疗服务联系起来，实现了可衡量的行为变化，以及持久的高质量临床结果。TRUST的三个目标是：1）评估应答者驱动抽样（RDS）作为招募工具，定义HCT和服务参与的障碍，量化检测和治疗的可接受性; 2）衡量TRUST干预对预防结果的影响; 3）定义最佳服务提供模式。为了实现这些目标，TRUST采用了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MSM社区招募1200名客户，在MSM社区信任场所提供全面的服务。量化HCT和治疗吸收的障碍。经验证的行为和创新的自我网络风险评估工具，以前开发的调查小组在其他低收入环境中，用于衡量行为模式和性行为之间的男男性接触者在尼日利亚，并监测TRUST参与行为和生物（事件艾滋病毒和性传播感染）的结果的影响。特别关注的是网络关系在影响行为中的作用，以及TRUST在理解和加强有利的以同伴为中介的行为规范方面的潜力。鉴于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模式将密集的综合预防干预措施与MSM社区“拥有”场所正在进行的全面临床服务提供联系起来，这是一个可能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（同行“任务转移”的影响）和客户（满意度）分析，对临床服务提供的优化进行评估。TRUST倡议的成果是：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）风险行为的驱动因素及其修改; 3）艾滋病毒和性传播感染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质量的客观评估。这些信息将共同指导建立信托基金规模p的最佳做法，作为总统艾滋病紧急救援计划提供服务的模式，具有很大的影响力。 公共卫生相关性：在艾滋病毒感染率居世界第二位的尼日利亚开展的TRUST项目评估了在支持男男性行为者的地方组织经营的社区场所提供全面综合预防、治疗和护理的影响。 这项研究调查了促进安全性行为对减少艾滋病毒感染的影响以及预防艾滋病治疗的影响。 如果这一模式取得成功，就可以将其扩大，以支持总统艾滋病紧急救援计划的目标，即为边缘化群体提供预防、护理和治疗，这些群体仍然是艾滋病毒/艾滋病流行病的主要驱动因素。

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.