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艾滋病毒预防试验网络（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行为的理解 在撒哈拉以南非洲（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）， 进一步开展艾滋病预防研究。这一目标在一项跨国的、前瞻性的生物行为学研究中得到了成功的解决。 在一年随访期内进行5次研究访视的队列。每次研究访视包括行为和临床 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，肯尼亚的基苏穆， 以及南非的开普敦和索韦托。HPTN 075显示出惊人的高艾滋病毒感染率， 撒哈拉以南非洲男男性行为者的发病率：在接受参与筛查的所有男男性行为者中，30%的人艾滋病毒检测呈阳性， 发病率为7.0/100人年（PY）（95%CI：4.3，10.6）。参与在避孕套肛门 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地点;对性行为的详细评估，包括 二元水平;以及具有广泛筛选数据和5次研究访视的纵向设计。这些丰富的数据将 用于促进我们对推动艾滋病毒传播的因素的理解，以及需要解决的问题， 艾滋病毒在撒南非洲的男男性行为者中流行，由于男男性行为者的高流行率， 妇女，在总人口中。将回答以下问题：（1）是否参与 在研究期间，由于研究相关的HIV风险咨询而改变无安全套肛交， 改善获得避孕套的机会，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， 与安全套的使用独立相关？(2)性行为的特征是什么 男男性接触者与女性之间的互动他们与男性的性互动与同性相比如何 男男性接触者与男性发生性关系的关系？(3)MSM的特征是什么？ 性交易中，她们和不这样做的男人有什么不同交易性的性互动有何不同 从非交易性的性互动中获得利益，以及以何种方式接受或提供利益 性交换会影响这些差异吗？(4)在男男性行为者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的发病率？ 还是插入肛交(5)不同国家的性行为是否存在差异， 同性性行为的法律的地位和社会接受度的国家差异？从这个研究结果 将为解决撒哈拉以南非洲男男性行为者需求的实施科学研究（R 01）的制定提供信息。