Parrying the Pitfalls of PrEP: Preventing Premature PrEP Discontinuation and STIs among Young Black MSM

避开 PrEP 的陷阱：防止年轻黑人 MSM 过早停止 PrEP 和性传播感染

• 批准号: 10652666
• 负责人: Colleen F Kelley
• 金额: $ 73.36万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10652666
• 关键词: AIDS prevention; Characteristics; Clinical; Consultations; Counseling; Data; Diagnosis; Dose; Doxycycline; Drug usage; Early Intervention; Elements; Eligibility Determination; Enrollment; Epidemic; Evaluation; HIV; HIV Infections; HIV Seronegativity; HIV diagnosis; Hour; Incidence; Infection; Intervention; Lead; Measures; National Institute of Drug Abuse; Oral; Outcome; Outcome Assessment; Pattern; Population; Prevention approach; Prevention strategy; Process Measure; Prophylactic treatment; Reporting; Risk; Role; Services; Sexually Transmitted Diseases; Study models; Surveys; System; United States; Visit; Work; aged; arm; black men who have sex with men; cohort; condoms; diaries; experience; falls; high risk; innovation; insight; interest; men; men who have sex with men; mobile application; motivational enhancement therapy; novel; peer; pill; premature; prevent; preventive intervention; primary outcome; prospective; randomized trial; response; screening; sex; side effect; success; trial design; uptake

Abstract Young (aged 18-29) Black men who have sex with men (YBMSM) in Atlanta experience high rates of HIV acquisition (8.9%/year) and STI infection (30%/year). Over the past 5 years, we have followed a cohort of 300 YBMSM in Atlanta and have offered PrEP as part of a comprehensive package of prevention interventions. We have had substantial uptake of PrEP – over 40% of YBMSM initiated PrEP – but we have also observed high rates of PrEP discontinuation (39% of all PrEP starts) and ongoing high rates of new STI diagnoses. Even with 44% PrEP uptake in the cohort, HIV incidence remained high at 6.2%/year. This represents a 30% reduction in HIV incidence compared to our pre-PrEP comparison cohort, but is still unacceptably high. Therefore, we proposed to continue our cohort approach but to add three new interventions: (1) an innovative “early warning” system to identify YBMSM on PrEP who are at risk for discontinuing PrEP, and providing a motivational interviewing-based peer intervention; (2) offering on-demand PrEP to men who decline daily PrEP or who plan to stop daily PrEP because they are unwilling to take a daily pill or perceive their risks to be infrequent; and (3) offering STI PEP with doxycycline for all men, regardless of PrEP use, to avert new STIs. This is an implementation-focused, single arm cohort approach, using a target trial design to emulate a randomized trial and evaluation of process measures. Primary outcomes are rates of PrEP discontinuation and rates of new STI diagnoses.

抽象的 年轻（18-29岁）与男性发生性关系的黑人（YBMSM）在亚特兰大经历了高艾滋病毒的率 收购（每年8.9％）和性传播感染感染（30％/年）。在过去的5年中，我们遵循了300人的队列 亚特兰大的YBMSM，并提供了PREP，作为全面预防干预措施的一部分。 我们已经大量吸收了PREP - 超过40％的YBMSM启动PREP - 但我们也观察到 高度停用率（占所有准备工作的39％）和新的STI诊断率持续的高率。 即使在队列中吸收44％的PREP，HIV事件仍为每年6.2％。这代表30％ 与我们的Prep Prep比较队列相比，HIV入口的减少，但仍然不可接受。 因此，我们建议继续我们的队列方法，但要添加三种新的干预措施：（1）一种创新的 “预警”系统以识别有可能停止准备的风险并提供的PREP的YBMSM 基于励志面试的同伴干预； （2）向每天拒绝每日准备的男性提供按需准备 或谁计划停止日常准备，因为他们不愿服用每日药或认为自己的风险是 罕见； （3）为所有男人提供强力霉素的STI PEP，无论使用什么准备，都可以避免新的性传播感染。 这是一种以实现为中心的单臂队列方法，使用目标试验设计来效仿 过程测量的随机试验和评估。主要结果是停用的准备率 和新的STI诊断率。