Assessing Psychosocial Predictors of PrEP Adherence and Persistence Among Young Black MSM

项目概要/摘要 与男性发生性关系的年轻黑人男性（YBMSM）继续经历不成比例的艾滋病毒感染率 在美国感染。艾滋病毒暴露前预防（PrEP）是一种生物医学预防干预措施 显示降低艾滋病毒感染的风险;然而，研究表明YBMSM不太可能被处方PrEP 并且与白色MSM相比，对PrEP的坚持程度显著较低。在YBMSM中使用PrEP是 估计在3%-20%之间。除了对依从性的关注，YBMSM中PrEP的持续性 低，在开始PrEP后6个月内的停药率在17%至22%之间。 风险和保护因素可能有助于该人群中PrEP的依从性和持久性。 初步证据表明YBMSM与心理社会之间的PrEP依从性之间的关系 因素在YBMSM中，耻辱感和自我感知的低艾滋病毒风险被认为是最常见的原因， PrEP拒绝。然而，目前尚不清楚这些发现是否可以扩展到对 由于缺乏关于YBMSM使用PrEP的生命周期的经验数据，因此YBMSM中的PrEP使用率很低。 使用风险和弹性框架，我们将进行混合方法研究，以了解自然生命 YBMSM在亚特兰大的PrEP使用周期。研究的具体目的是描述 YBMSM中PrEP使用生命周期中的PrEP依从性;识别和描述心理社会风险， PrEP持续性和依从性的保护因素;并确定未来PrEP的干预目标 坚持干预。为了实现这些目标，在目标1中，我们将跟踪100名YBMSM新启动的PrEP， 个月参与者将完成每周评估他们的PrEP使用和性行为每周为 前90天，然后每月一次。每季度，参与者还将完成以下评估： 社会心理领域（抑郁症、物质使用、社会支持、感知艾滋病毒风险）。 将使用自我报告项目记录依从性，并通过自我采集的干血斑（DBS）进行确认 在三个月和六个月时进行测试。在目标2中，多达40名YBMSM将完成深入的个人访谈（IDI） 描述他们使用PrEP的经历，强调他们对日常依从性的决定， 心理社会风险和保护因素，有助于他们的坚持和持久性水平，或 最后，利用与下列因素相关的社会心理风险和保护因素， 目标1中的PrEP中止和PrEP持续性以及个人访谈的内容和示例 在目标2中，在目标3中，我们将确定与PrEP依从性相关的社会心理干预目标。本研究 将为制定干预措施奠定基础，以支持PrEP的坚持和持久性， 这个人口。

Project Summary/Abstract Young Black men who have sex with men (YBMSM) continue to experience a disproportionate rate of HIV infections in the United States. HIV pre-exposure prophylaxis (PrEP) is a biomedical prevention intervention shown to reduce risk of HIV infection; however, studies suggest YBMSM are less likely to be prescribed PrEP and have significantly lower levels of adherence to PrEP compared to white MSM. PrEP use among YBMSM is estimated at between 3%-20%. In addition to concerns with adherence, persistence on PrEP among YBMSM is low, with discontinuation rates ranging between 17% to 22% within 6 months of starting PrEP. Psychosocial risk and protective factors might contribute to PrEP adherence and persistence among this population. Preliminary evidence suggests a relationship between PrEP adherence among YBMSM and psychosocial factors. Among YBMSM, stigma and low self-perceived HIV risk were cited as the most common reasons for PrEP refusal. However, it is not clear that these findings can be extended to adherence and persistence to PrEP among YBMSM because of the lack of the empirical data on the life cycle of PrEP use among YBMSM. Using a risk and resiliency framework, we will conduct a mixed methods study to understand the natural life cycle of PrEP use among YBMSM in Atlanta. The specific aims of the study are to characterize the patterns of PrEP adherence in the life cycle of PrEP use among YBMSM; identify and describe the psychosocial risk and protective factors to PrEP persistence and adherence; and identify intervention targets for a future PrEP adherence intervention. To achieve these aims, in Aim 1 we will follow 100 YBMSM newly-initiating PrEP for 6 months. Participants will complete weekly assessments of their PrEP use and sexual behavior weekly for the first 90 days and then monthly thereafter. Quarterly, participants will also complete assessments of psychosocial domains (depressive symptomatology, substance use, social support, perceived HIV risk). Adherence will be captured using a self-report item and confirmed via self-collected dried blood spot (DBS) testing at three and six months. In Aim 2, up to 40 YBMSM will complete in-depth individual interviews (IDIs) describing their experiences using PrEP, highlighting their decisions about daily adherence and the psychosocial risk and protective factors that contributed to their levels of adherence and persistence or discontinuation of PrEP. Lastly, drawing upon the psychosocial risk and protective factors associated with PrEP discontinuation and PrEP persistence in Aim 1 and the content and examples from individual interviews in Aim 2, in Aim 3 we will identify psychosocial intervention targets associated with PrEP adherence. This study will lay the foundation for the development of interventions to support PrEP adherence and persistence among this population.