Using Behavioral Measures to Assess Change in HIV Sexual Risk-Taking Following Pre-Exposure Prophylaxis (PrEP) Uptake in Heavy Drinking Young Men Who Have Sex With Men

项目总结/摘要 男男性行为的年轻成年男子（18-30岁）的艾滋病毒感染率高得不成比例 (MSM)部分原因是重叠的风险因素，如高饮酒率。暴露前预防 （PrEP）是一种有效的艾滋病毒预防药物，但如果没有很强的依从性，则几乎没有效用。潜在风险 补偿-性冒险的增加（例如，更多的无套性行为），因为PrEP使用者认为他们的风险 减少-是另一个相当大的关注与PrEP，因为PrEP不保护免受其他 性传播感染（STIs）。大量证据表明，酒精通过以下方式促进艾滋病毒的传播： 增加性风险和减少药物依从性，加剧了PrEP的两个关键问题 - 增加性风险和减少PrEP依从性。然而，酒精却很少受到关注， PrEP和风险补偿文献，只有两项研究报告了酒精使用情况。 此外，关于PrEP和风险补偿的研究充满了方法上的局限性，包括例外， 严重依赖回顾性自我报告，主要由横断面研究组成。研究审查 PrEP和风险补偿是不确定的，部分原因是这些限制。迫切需要解决 这是因为四分之一的医生报告说，由于风险补偿问题，他们不愿意开PrEP。因此，在本发明中， 拟议的研究将通过确定PrEP和酒精使用的影响来解决这些差距和限制 在PrEP摄入前后使用新的行为措施来进行性冒险。 拟议的项目将使用性延迟折扣任务（SDDT）前和后PrEP摄取检查 艾滋病毒性风险的变化，并确定与酒精使用，需求和强化的关联。的 SDDT是一种新的衡量性冒险的方法，它最大限度地减少了回顾性自我报告，是可靠和有效的，但 利用不足。SDDT评估了伴侣性传播感染/艾滋病毒状况和安全套供应对性传播感染可能性的影响。 避孕套的使用，并已显示出更强的关系，临床结果相比，自我报告和其他折扣- 的措施。尽管有这些有希望的支持证据，SDDT还没有被用作结果测量 在干预研究中。本研究将建立SDDT的有效性，作为未来研究的结果指标， 为研究测试干预措施提供了一个新的目标，以减少饮酒和性冒险。 拟议的F31将增强NIAAA资助的随机对照试验（UH 2/UH 3AA 026214，Leeman）测试 移动的干预，以减少酒精滥用和提高PrEP依从性。酗酒的年轻男男性接触者 （N = 80）将接受开放标签PrEP 30天，随访6个月。无治疗对照组（无 将为F31添加PrEP;无干预; N = 40），以按照相同的时间轴完成研究措施。 这个F31将使申请人能够与一个高技能，经验丰富的培训团队合作， 在：（1）随机对照试验和实验方法;（2）行为经济学的应用;和（3） 纵向数据分析，为酒精/艾滋病毒研究的独立调查员职业生涯做准备。

Project Summary/Abstract HIV incidence rates are disproportionately high among young adult (ages 18-30) men who have sex with men (MSM), in part due to overlapping risk-factors, such as high rates of alcohol use. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention drug, but has little utility without strong adherence. The potential for risk compensation – an increase in sexual risk-taking (e.g., more condomless sex) as PrEP users believe their risk for HIV is reduced – is another considerable concern with PrEP, because PrEP does not protect against other sexually transmitted infections (STIs). Substantial evidence indicates that alcohol facilities the spread of HIV by increasing sexual risk-taking and reducing medication adherence, exacerbating both critical concerns with PrEP – increased sexual risk-taking and reduced PrEP adherence. However, alcohol has received little attention in the PrEP and risk compensation literature, with only two studies reporting on alcohol use. Further, research on PrEP and risk compensation is replete with methodological limitations, including an exclu- sive reliance on retrospective self-reports and largely consists of cross-sectional studies. Research examining PrEP and risk compensation is inconclusive, in part due to these limitations. There is an urgent need to address this as a quarter of physicians report unwillingness to prescribe PrEP due to risk compensation concerns. Thus, the proposed study will address these gaps and limitations by determining the effects of PrEP and alcohol use on sexual risk-taking by using novel behavioral measures before and after PrEP uptake. The proposed project will use the Sexual Delay Discounting Task (SDDT) pre- and post-PrEP uptake to examine changes in HIV sexual risk-taking and determine associations with alcohol use, demand and reinforcement. The SDDT is a novel measure of sexual risk-taking that minimizes retrospective self-report, is reliable and valid, yet underutilized. The SDDT assesses impact of partner STI/HIV status and condom availability on likelihood of condom use, and has shown stronger relations to clinical outcomes, compared to self-report and other discount- ing measures. Despite this promising supporting evidence, the SDDT has not been used as an outcome measure in intervention studies. This study will establish validity of the SDDT as an outcome measure for future studies, providing a novel target for research testing interventions to reduce alcohol use and sexual risk-taking. The proposed F31 will enhance a NIAAA-funded randomized control trial (UH2/UH3AA026214, Leeman) testing a mobile intervention to reduce alcohol misuse and enhance PrEP adherence. Heavy drinking young adult MSM (N = 80) will receive open-label PrEP for 30 days, with a follow-up at 6-months. A no treatment control group (no PrEP; no intervention; N = 40) will be added for the F31 to complete study measures following the same timeline. This F31 will enable the applicant to work with a highly-skilled, experienced training team to develop proficiencies in: (1) randomized controlled trial and experimental methods; (2) application of behavioral economics; and (3) longitudinal data analysis to prepare for a career as independent investigator in alcohol/HIV research.