TRUST

描述(由申请人提供)：全球艾滋病协调员办公室(OGAC)关于组合艾滋病毒预防的技术指南为MSM及其合作伙伴定义了一个全面的艾滋病毒预防服务计划。当前的提案“在可信的社区场所以网络为基础招募MSM进入HCT、护理、治疗和预防服务”(TRUST)进行了一项运筹学前瞻性队列研究，评估了在综合服务模式中使用OGAC计划的每个要素的干预措施。信任的核心假设是，通过网络招聘来扩大尼日利亚MSM的参与度，将客户与社区信任的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，可以实现可衡量的行为变化，并获得持久的高质量临床结果。信任的三个目标是：1)评估受访者驱动抽样(RDS)作为一种招募工具，确定HCT和服务参与的障碍，并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)确定最优服务交付模式。为了实现这些目标，Trust聘请了RDS，这是一种数学定义的同行驱动型连锁推荐方法，从阿布贾和拉各斯的MSM社区招募1200名客户，在以MSM社区为基础的可信场所提供全面的服务。对红细胞压积和治疗吸收的障碍进行了量化。研究小组先前在其他低收入环境中开发的经过验证的行为和创新的自我网络风险评估工具被用于测量尼日利亚MSM的行为模式和性行为，并监测信任参与对行为和生物学(艾滋病毒和性传播感染事件)结果的影响。一个特别的焦点是网络关系在影响行为中的作用，以及信任在理解和加强良好的同行中介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往往会随着时间的推移而失效，信任模式将密集的组合预防干预措施与MSM社区“拥有”场所正在进行的全面临床服务提供联系起来，是一个潜在的平台，它可能会加强持续和持久的行为改变，而这种改变是由“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)分析来评估临床服务提供的优化。信托倡议的成果是：1)扩大对尼日利亚男男性接触者社会和性网络范围的了解；2)风险做法及其改变的驱动因素；3)艾滋病毒和性传播感染治疗和联合预防的影响，以减少高危行为和性行为；4)对在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。综合起来，这些信息将指导机构将信托规模p作为可能产生重大影响的PEPFAR服务交付模式的最佳做法。 与公共卫生相关：该信托项目在尼日利亚开展，是世界第二大艾滋病毒项目，评估了在当地支持男男性行为的组织运营的社区场所提供全面和综合的预防、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，以及预防艾滋病的治疗的影响。如果该模式成功，它可以扩大到支持PEPFAR对边缘化人群的预防、护理和治疗目标，这些人群仍然是艾滋病毒/艾滋病流行的重要驱动力。

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.