A family-based intervention to improve HIV pre-exposure prophylaxis uptake for adolescent sexual minority males

以家庭为基础的干预措施，以提高性少数青少年男性对艾滋病毒暴露前预防的接受率

• 批准号: 10013417
• 负责人: Jack Rusley
• 金额: $ 16.89万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10013417
• 关键词: AIDS prevention; Address; Adolescence; Adolescent; Adolescent Medicine; Adolescent and Young Adult; Adult; Age; Area; Behavior; Behavior Therapy; Behavioral Sciences; Bisexual; Centers for Disease Control and Prevention (U.S.); Child; Childhood; Clinical Research; Communication; Counseling; Data; Disclosure; Education; Effectiveness; Effectiveness of Interventions; Environment; Ethical Issues; Family; Foundations; Fumarates; Funding; Gays; Goals; HIV; HIV Infections; HIV risk; Hospitals; Incidence; Individual; Interdisciplinary Study; Intervention; Intervention Trial; Interview; Knowledge; Learning Module; Male Adolescents; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Motivation; Outcome; Parents; Participant; Play; Population; Populations at Risk; Prevention; Prevention Research; Prevention strategy; Preventive Intervention; Primary Health Care; Process; Public Health; Randomized; Research; Research Personnel; Rhode Island; Risk; Risk Behaviors; Risk Reduction; Role; Sampling; Scientist; Sexual Health; Sexuality; Source; Tenofovir; Testing; Time; Training; Trust; United States; United States National Institutes of Health; Universities; Work; Youth; attentional control; base; behavior change; care providers; career; critical developmental period; design; emtricitabine; evidence base; experience; follow-up; formative assessment; group intervention; health disparity; high risk; high risk population; implementation science; improved; interest; intervention effect; male; male health; men; men who have sex with men; motivational enhancement therapy; parental involvement; pre-exposure prophylaxis; prevent; primary care setting; primary outcome; randomized trial; recruit; risk perception; secondary outcome; sexual debut; sexual minority; skills; success; therapy development; tool; transmission process; uptake; young man

PROJECT SUMMARY/ABSTRACT Dr. Rusley is pursuing this K23 Mentored Patient-Oriented Research Career Development Award to facilitate his transition to an independent HIV prevention scientist. His career goal is to eliminate health disparities among adolescents and young adults at risk for HIV. He has a background in pediatric and adolescent medicine, clinical research, public health, and motivational interviewing (MI) that create a strong foundation for the proposed training and research plan. He has assembled a highly accomplished and diverse team of mentors with complementary expertise in adolescent sexual minority male (ASMM) health, HIV prevention including pre-exposure prophylaxis (PrEP), behavioral interventions, family-based interventions, implementation science, and ethical issues in adolescent sexuality research. These mentors, along with an excellent and highly-interdisciplinary research environment at Brown University and Rhode Island Hospital will facilitate his training and research plan, as well as his transition to an independent, NIH- funded researcher. Given the disproportionate burden of HIV borne by sexual minority males in the US—especially young men—and the fact that most of these men have their first sexual experience as adolescents, ASMM are a key population for HIV prevention interventions. However, there are very few evidence-based HIV prevention interventions for this group, in part due to complexities with parental involvement in research. Many experts have called for inclusion of parents in HIV prevention interventions for ASMM, given the key protective roles they can play in their children’s lives; yet there are no family-based HIV prevention interventions for ASMM in the US. PrEP is a highly effective HIV prevention tool that has recently been added to the existing HIV prevention toolkit with FDA approval for adolescents in 2018, yet uptake among ASMM has been low. The few studies that address this gap in PrEP uptake among ASMM suggest possible barriers may include: concerns about disclosure of sexuality to parents (“outing”), knowledge of and motivation to use PrEP, and lack of access to primary care clinicians who prescribe PrEP. Therefore, we will develop a family-based HIV prevention intervention for ASMM that can be used in primary care settings. First, we will conduct a formative evaluation using in-depth individual interviews with ASMM (n=12-15) and parents (n=12-15) to determine barriers and facilitators to the success of the planned intervention (Specific Aim (SA) 1). Second, we will adapt an existing evidenced-based, motivational interviewing (MI) intervention to include PrEP education and counseling, as well as a family-based component (a video-based education module about parental support, sexuality communication, and PrEP as HIV prevention). We will then pilot the intervention with ASMM-parent dyads (n=10) (SA2). Finally, we will conduct an exploratory randomized trial of the intervention with ASMM-parent dyads (n=100) to test its effect on PrEP uptake at baseline and 8-week follow up, and to determine feasibility and acceptability (SA3). Overall, the intervention will reach a difficult to access population, build protective parent relationships, and increase PrEP uptake among a key population at risk, thereby reducing new HIV infections. The proposed training and research plan will provide Dr. Rusley the experience and mentoring needed to expand his skills and become an independent and leading HIV prevention scientist.

项目概要/摘要 Rusley 博士正在争取获得 K23 指导的以患者为导向的研究职业发展奖，以促进他的 转变为独立的艾滋病毒预防科学家。他的职业目标是消除不同人群之间的健康差距 有感染艾滋病毒风险的青少年和年轻人。他拥有儿科和青少年医学、临床医学背景 研究、公共卫生和动机访谈（MI），为拟议的培训和培训奠定了坚实的基础 研究计划。他组建了一支卓有成就且多元化的导师团队，他们在以下领域具有互补的专业知识 青少年性少数男性 (ASMM) 健康、艾滋病毒预防，包括暴露前预防 (PrEP)、行为 青少年性行为研究中的干预措施、基于家庭的干预措施、实施科学和伦理问题。 这些导师，以及布朗大学优秀的、高度跨学科的研究环境， 罗德岛医院将促进他的培训和研究计划，以及他向独立的 NIH 过渡。 资助的研究员。鉴于美国性少数男性承担的艾滋病毒负担不成比例，尤其是 年轻男性——事实上，这些男性中的大多数在青少年时期就有了第一次性经历，ASMM 是一个关键 人群的艾滋病毒预防干预措施。然而，基于证据的艾滋病毒预防干预措施很少 对于这一群体来说，部分原因是父母参与研究的复杂性。多位专家呼吁纳入 考虑到父母在 ASMM 的艾滋病毒预防干预中可以发挥的关键保护作用 生活；然而，美国没有针对 ASMM 的基于家庭的 HIV 预防干预措施。 PrEP 是一种高效的 HIV 最近已被添加到现有的艾滋病毒预防工具包中，并经 FDA 批准用于青少年 2018 年，但 ASMM 的采用率一直很低。少数研究解决了 ASMM 中 PrEP 吸收方面的差距 建议可能的障碍可能包括：担心向父母透露性行为（“外出”）、了解和 使用 PrEP 的动机，以及缺乏开具 PrEP 处方的初级保健临床医生的机会。因此，我们将开发一个 针对 ASMM 的基于家庭的 HIV 预防干预措施，可用于初级保健机构。首先，我们将进行一次 通过与 ASMM (n=12-15) 和家长 (n=12-15) 进行深入的个人访谈进行形成性评估，以确定 计划干预措施成功的障碍和促进因素（具体目标 (SA) 1）。其次，我们将调整 现有的循证动机访谈 (MI) 干预措施，包括 PrEP 教育和咨询，以及 作为基于家庭的组成部分（关于父母支持、性沟通和性行为的基于视频的教育模块） PrEP 作为 HIV 预防）。然后，我们将用 ASMM 父母二元组 (n=10) (SA2) 进行试点干预。最后，我们将 对 ASMM 父母二人组 (n=100) 进行干预的探索性随机试验，以测试其对 PrEP 的影响 基线和 8 周随访时的吸收情况，并确定可行性和可接受性 (SA3)。总体而言，干预 将接触到难以接触的人群，建立保护性父母关系，并提高关键人群中 PrEP 的采用率 面临风险的人群，从而减少新的艾滋病毒感染。拟议的培训和研究计划将为 Rusley 博士提供 扩展技能并成为独立且领先的艾滋病毒预防人员所需的经验和指导 科学家。