San Francisco-Rio de Janeiro collaborative research on HIV prevalence, risk, and biomedical prevention interventions among young men who have sex with men

摘要 随着旧金山弗朗西斯科的艾滋病疫情将达到零感染，里约热内卢正在经历 男男性行为者中新报告的艾滋病毒病例有所回升。弗朗西斯科的成功 这归功于有效的生物医学干预措施，即：快速诊断，立即抗逆转录病毒疗法， 持续的病毒载量抑制，广泛吸收PrEP，并中断新的集群， 传输然而，在巴西，迄今为止，这些生物医学干预措施的采用 尽管是第一个提供援助的低/中等收入国家， 向所有艾滋病毒感染者提供免费抗逆转录病毒治疗，参与证明PrEP疗效的临床试验，以及 同时，年轻的男男性接触者，特别是黑人/非洲裔巴西人， HIV发病率高，病毒抑制率低，PrEP依从性差。因此我们 建议在旧金山弗朗西斯科公共卫生部和 Oswaldo Cruz Foundation（Fiocruz）in Rio de Janeiro.我们将集中精力确定 艾滋病毒感染、消除生物医学干预障碍的方法以及确定障碍 将年轻的男男性接触者纳入生物医学研究。方法包括一个横断面调查， 18-24岁男男性接触者，采用基于社交媒体的抽样，采用受访者驱动的抽样; 开发基于技术的快速ART和PrEP参与和保留 干预;以及对15-17岁的MSM，他们的父母和性服务提供者的定性研究 卫生服务，以更好地了解风险的发生和增加包容性的可行性， 未成年人在生物医学艾滋病毒研究和干预方案。旧金山弗朗西斯科是 美国消除艾滋病毒的测试案例，但在接触年轻人方面仍然存在挑战 少数的MSM里约热内卢是南美洲艾滋病研究的引擎，但面临着 在获得经证实的男男性行为者生物医学干预措施的好处方面面临的挑战。拟议 美国与巴西的研究合作将在提高 采取生物医学干预措施，以扭转巴西男男性行为者中艾滋病毒的流行， 在美国仍然存在差距。

ABSTRACT As San Francisco’s HIV epidemic is set to reach zero infections, Rio de Janeiro is experiencing a resurgence in new reported HIV cases among MSM. San Francisco’s success can be attributed to effective biomedical interventions, namely: rapid diagnosis, immediate ART, sustained viral load suppression, wide uptake of PrEP, and interrupting new clusters of transmission. In Brazil, however, uptake of these biomedical interventions has so far been insufficient to reverse the epidemic, despite being the first low/middle income country to provide free ART to all persons with HIV, participation in clinical trials proving PrEP efficacy, and national policy to provide free PrEP. Meanwhile, young MSM, particularly Black/Afro-Brazilians, have high HIV incidence, low viral suppression, and poor PrEP adherence. We therefore propose collaborative research between the San Francisco Department of Public Health and the Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro. We will focus on identifying the drivers of HIV infection, ways to address barriers to biomedical interventions, and identifying the hurdles to including young MSM in biomedical research. Methods include a cross-sectional survey of MSM age 18-24 using respondent-driven sampling adapted for social media-based sampling; development of a technology-based rapid ART and PrEP engagement and retention intervention; and a qualitative study of MSM age 15-17, their parents, and providers of sexual health services to better understand the onset of risk and the feasibility of increasing inclusion of minors in biomedical HIV research and intervention programs. San Francisco stands as an American test case for the elimination of HIV, yet remaining challenges exist in reaching young and minority MSM. Rio de Janeiro is an engine of HIV research in South America, yet faces challenges in reaping the benefit of proven biomedical interventions for MSM. The proposed US-Brazil research collaboration will provide mutual benefit in increasing the effectiveness of biomedical interventions to reverse the HIV epidemic among MSM in Brazil and address remaining disparities in the US.