Enhancing HIV Pre-Exposure Prophylaxis (PrEP) by Targeting Hazardous Alcohol Use and Concurrent Conditions

尽管暴露前预防(PrEP)构成了一种高效的生物医学艾滋病毒预防 策略，其有效性已被证明依赖于治疗依从性、在护理中的保留和 继续使用避孕套。识别和解决影响这些PrEP相关行为的因素 因此，对于最大限度地发挥PrEP的艾滋病毒预防效益来说，这是当务之急。有害的酒精消费， 以及同时发生的疾病，如药物使用和抑郁，已被证明会对 各种健康行为，尽管这些担忧在服用PrEP处方药的男性中普遍存在 在男男性行为(MSM)中，很少有人研究他们在PrEP治疗中的作用。现在 研究涉及两个阶段的方法，旨在1)更好地了解 服用PrEP处方者中的酒精使用、同时使用药物和抑郁以及PrEP相关行为 MSM(UH2阶段)；和2)探索解决危险饮酒和并发疾病是否可以 可能导致MSM PrEP相关行为的改善(UH3阶段)。最近完成的第一个 这项研究的阶段(UH2)包括1)五个焦点小组与PrEP处方的MSM(N=35)来探索 PrEP坚持的障碍、PrEP相关护理中的保留和避孕套的使用；重点是酒精 消费和并发情况；2)对141名服用PrEP处方的男男性接触者进行调查，以确定 坚持PrEP、无避孕套的性行为、危险饮酒和并发疾病之间的关联； 对501名服用PrEP处方的男男性接触者进行图表提取，以确定临床确定的患病率和相关性 其中，危险饮酒和并发疾病；遵守PrEP；保留在PrEP相关护理中；以及 性传播感染。在这项初步工作的基础上，这项研究的第二阶段(UH3)将需要 一项试点随机对照试验，其中120名危险饮酒、PrEP处方的MSM将随机 被分配接受片剂为基础的短期戒酒干预或照常治疗。 参与者被分配到前一种情况，他们对药物使用和/或抑郁相关的担忧 将提供指向相关资源的链接。所有试验参与者将完成生物标记物测试 并在基线、3个月和6个月进行自我报告评估，以评估 对酒精使用、PrEP坚持、护理中的保留和无避孕套的性行为进行干预。可行性和 还将审查干预措施的可接受性。综上所述，这两个阶段的发现 研究不仅将为危险饮酒的可能影响提供亟需的洞察力，还将 关于PrEP治疗的同时条件，但它们也将有可能指导未来旨在 在提高PrEP治疗效果方面。

Although HIV pre-exposure prophylaxis (PrEP) constitutes a highly effective biomedical HIV prevention strategy, its effectiveness has been shown to be dependent on treatment adherence, retention in care, and the continued use of condoms. Identifying and addressing factors that detract from these PrEP-relevant behaviors is therefore imperative for maximizing the HIV preventive benefits of PrEP. Hazardous alcohol consumption, and concurrent conditions such as substance use and depression, have been shown to adversely impact a variety of health behaviors, and although these concerns are prevalent among PrEP-prescribed men who have sex with men (MSM), little work has been conducted to investigate their role in PrEP treatment. The present study involves a two-phased approach designed to 1) gain a better understanding of the associations among alcohol use, concurrent substance use and depression, and PrEP-related behaviors among PrEP-prescribed MSM (UH2 phase); and 2) explore whether addressing hazardous drinking and concurrent conditions can potentially lead to improvements in MSM’s PrEP-related behaviors (UH3 phase). The recently completed first phase of this research (UH2) involved 1) five focus groups with PrEP-prescribed MSM (N=35) to explore barriers to PrEP adherence, retention in PrEP-related care, and condom use; with an emphasis on alcohol consumption and concurrent conditions; 2) surveys with 141 PrEP-prescribed MSM to identify rates of, and associations among, PrEP adherence, condomless sex, hazardous drinking, and concurrent conditions; and 3) chart extraction of 501 PrEP-prescribed MSM to ascertain clinically-identified rates of, and associations among, hazardous drinking and concurrent conditions; PrEP adherence; retention in PrEP-related care; and sexually transmitted infections. Building on this initial work, the second phase of this research (UH3) will entail a pilot randomized controlled trial in which 120 hazardous drinking, PrEP-prescribed MSM will be randomly assigned to receive either a tablet-based, alcohol-reduction brief intervention or treatment-as-usual. Participants assigned to the former condition for whom substance use- and/or depression-related concerns are identified will be provided with links to relevant resources. All trial participants will complete biomarker testing and self-report assessments at baseline, 3-months, and 6-months to assess the preliminary impact of the intervention on alcohol use, PrEP adherence, retention in care, and condomless sex. Feasibility and acceptability of the intervention will also be examined. Taken together, findings from both phases of this research will not only provide much needed insight into the possible impact of hazardous alcohol use and concurrent conditions on PrEP treatment, but they will also have the potential to guide future initiatives aimed at enhancing PrEP treatment effectiveness.