In-depth Understanding of HIV Risk Behavior among Men Who Have Sex With Men in Sub-Saharan Africa: Secondary Analysis of HPTN 075 Data

深入了解撒哈拉以南非洲地区男男性行为者的艾滋病毒风险行为：HPTN 075 数据的二次分析

• 批准号: 10645082
• 负责人: Theodorus G.M. Sandfort
• 金额: $ 24.02万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10645082
• 关键词: AIDS prevention; Address; Affect; Africa South of the Sahara; Age; Anal Sex; Behavior assessment; Characteristics; Clinical assessments; Communities; Counseling; Country; Data; Data Analyses; Data Set; Development; Drug resistance; Enrollment; Ensure; Epidemic; General Population; HIV; HIV Infections; HIV Seropositivity; HIV prevention trials network; HIV risk; High Prevalence; Human immunodeficiency virus test; Immune; Improve Access; Incidence; Individual; Infectious Diseases Research; Intervention; Kenya; Knowledge; Legal Status; Malawi; Mediating; Motivation; Outcome Study; Paper; Participant; Pattern; Peer Review; Persons; Population; Preparation; Prevalence; Publications; Publishing; Reporting; Research; Risk; Risk Behaviors; Role; Safe Sex; Same-sex; Sampling; Sex Behavior; Sex Counseling; Sexuality; Site; South Africa; Subgroup; Testing; Transact; Visit; Woman; Work; biobehavior; cohort; condomless anal sex; condoms; design; evidence base; follow-up; high risk population; implementation science; interest; longitudinal design; meetings; men; men who have sex with men; men who have sex with men and women; patient engagement; prevent; preventive intervention; prospective; recruit; resistance mutation; response; risk perception; screening; screening participation; secondary analysis; sex; sexual encounter; social; substance use; substance user; tool; transmission process; virtual

The aim of this project is to use the rich data collected for the HIV Prevention Trials Network (HPTN) 075 study to expand our understanding of the sexual behavior and HIV risk practices of men who have sex with men (MSM) in sub-Saharan Africa (SSA). HPTN 075 was a vanguard study with the primary aim to assess the feasibility of recruiting and retaining 400 men who have sex with men (MSM) in sub-Saharan Africa (SSA) in preparation for further HIV prevention studies. This aim was successfully addressed in a multinational, prospective biobehavioral cohort with five study visits over a one-year follow-up period. Each study visit included behavioral and clinical assessments. The study was conducted from 2015 to 2017 in four sites: Blantyre in Malawi, Kisumu in Kenya, and Cape Town and Soweto in South Africa. HPTN 075 showed an alarmingly high HIV prevalence and incidence among MSM in SSA: 30% of all MSM screened for participation tested HIV positive and an overall incidence was found of 7.0/100 person-years (PY) (95% CI: 4.3, 10.6). Engagement in condomless anal intercourse was the strongest determinant of incidence. The HPTN 075 data set is exceptionally rich: the involvement of four study sites in three countries; detailed assessments of sexual behavior, including on the dyad-level; and the longitudinal design with extensive screening data and five study visits. This rich data will be used to advance our understanding of factors that drive HIV transmission and that need to be addressed to end the HIV epidemic in SSA among MSM and, because of the high prevalence of MSM who also have sex with women, among the general population. The following questions will be answered: (1) Does engagement in condomless anal sex change over the duration of the study due to study-related HIV-risk counseling and improved access to condoms, and which characteristics of the individual (e.g., age, HIV risk perception), the sexual partnership (e.g., age concordance, relationship status), and the sexual encounter (e.g., substance use, place of interaction) are independently associated with condom use? (2) What are the features of sexual interactions that MSM have with women? How do their sexual interactions with men compare to the same-sex interactions of MSM who exclusively have sex with men? (3) What are the characteristics of MSM who engage in transactional sex and how do they differ from men who do not? How are transactional sex interactions different from sexual interactions that are not transactional, and in what way does receiving or providing benefits in exchange for sex affect these differences? (4) What patterns of substance use can be distinguished among MSM in SSA? Are these patterns predictive of HIV incidence and what is the mediating role of condomless receptive or insertive anal sex? (5) Are there differences between countries in sexual behaviors corresponding to the national differences in the legal status and social acceptance of same-sex sexuality? Findings from this study will inform the development of an implementation science study (R01) addressing the needs of MSM in SSA.

该项目的目的是利用为 HIV 预防试验网络 (HPTN) 075 研究收集的丰富数据 扩大我们对男男性行为者 (MSM) 的性行为和艾滋病毒风险做法的了解 撒哈拉以南非洲 (SSA)。 HPTN 075 是一项先锋研究，主要目的是评估 在撒哈拉以南非洲 (SSA) 招募并留住 400 名男男性行为者 (MSM)，为 进一步的艾滋病毒预防研究。这一目标已在一项跨国前瞻性生物行为研究中成功实现 在一年的随访期内进行了五次研究访问的队列。每次研究访问都包括行为和临床 评估。该研究于 2015 年至 2017 年在四个地点进行：马拉维的布兰太尔、肯尼亚的基苏木、 以及南非的开普敦和索韦托。 HPTN 075 显示出惊人的高 HIV 患病率 SSA 中 MSM 的发病率：在参与筛查的所有 MSM 中，有 30% 的 HIV 检测呈阳性，总体 发病率为 7.0/100 人年 (PY)（95% CI：4.3，10.6）。参与无套肛门 性交是发病率最强的决定因素。 HPTN 075 数据集异常丰富： 涉及三个国家的四个研究中心；对性行为的详细评估，包括 二元级别；以及具有广泛筛选数据和五次研究访问的纵向设计。这些丰富的数据将 用于增进我们对驱动艾滋病毒传播以及需要解决以结束艾滋病毒传播的因素的理解 SSA 的 MSM 中艾滋病毒流行情况，并且由于同时与性行为者发生性行为的 MSM 患病率很高 妇女，在一般人群中。回答以下问题： (1) 参与是否参与 由于研究相关的艾滋病毒风险咨询和研究期间无套肛交的性别变化 改善获得安全套的机会，以及个人的哪些特征（例如年龄、艾滋病毒风险认知）、 性伙伴关系（例如，年龄一致性、关系状态）和性接触（例如，物质使用、 互动地点）与安全套的使用独立相关吗？ (2) 性的特点是什么 MSM 与女性的互动？与同性相比，他们与男性的性互动如何 只与男性发生性关系的 MSM 的互动？ (3) 从事MSM活动的人群有哪些特点 她们与不进行性交易的男性有何不同？交易性性互动有何不同 非交易性的性互动，以及以什么方式接收或提供利益 性交换会影响这些差异吗？ (4) MSM 中可以区分哪些物质使用模式 在SSA？这些模式是否可以预测艾滋病毒的发病率？无套接受的中介作用是什么？ 还是插入式肛交？ (5) 不同国家的性行为是否存在相应的差异？ 同性性行为的法律地位和社会接受程度存在国家差异吗？这项研究的结果 将为开展一项实施科学研究 (R01) 提供信息，以满足 SSA 中 MSM 的需求。