Using EMA to developmentally tailor an intervention to support on-demand PrEP among YMSM

项目摘要 在美国，与男性发生性关系的青少年和年轻成年男性（YMSM）承担着沉重的艾滋病毒负担。 美国。尽管有非常有效的每日口服艾滋病毒暴露前预防（PrEP）， 而且YMSM对PrEP的依从性仍然很低。每天服用避孕药的挑战，以及对 关于药物的副作用，已被确定为低于预期摄取的原因， 年轻人中的PrEP，特别是YMSM的颜色。按需或事件驱动的PrEP已被证明是 在成年男男性接触者中有效，但迄今为止尚未在青年男男性接触者中进行检查。现有文献数据 支持YMSM有和没有经验与PrEP显示有兴趣探索不同剂量 战略布局这种兴趣可能会转化为更多的PrEP吸收，特别是在那些有 表示不愿意尝试每日方案或没有成功坚持每日方案。而 来自青少年治疗研究的初步证据表明，间歇性治疗方案可能是可行的， 青年，他们正在进行的执行功能的发展，加上更高的反应， 社会情绪背景，对性行为和预防性健康的决策有影响 在乎此外，青少年常见的特征--包括冲动和寻求感觉-- 显示出显着和有意义的协会与行为的地方YMSM艾滋病毒的风险。为 由于这些原因，“按需”的可变战略可能对仍在发育中的青年人具有挑战性， 认知上，需要适当的干预措施，以最大限度地提高他们的成功。虽然研究 按需PrEP策略表明，成年MSM很难准确预测性行为何时发生。 发生，这还没有在YMSM中探索。拟议的研究填补了这些重要的空白， 了解，以指导未来的需求PrEP干预与YMSM。这项研究将提供见解， YMSM中按需PrEP的潜在发展障碍，并为创新的 通过完成三个具体目标，采取干预办法解决这些问题。具体目标1和2将 提供发展和认知的促进者和障碍，按需PrEP的更好的理解。 为了实现这些目标，将招募120名青年（年龄16-24岁），每天完成一项 8周的电子日记，记录他们对性接触的预测和实际参与。 在基线和研究完成时进行的调查将衡量发展和社会文化因素 可能影响风险预测（如执行功能、冲动性、计划）和潜在干预 方法（例如，要点与逐字信息，奖励敏感性）。目标3中的焦点小组将有助于 将目标1和2的发现转化为及时干预，以提高YMSM计划 性活动，并根据准确的风险认知纳入PrEP剂量。青年咨询委员会 将举行会议，就干预措施的设计提供反馈意见。

Project Abstract Adolescent and young adult men who have sex with men (YMSM) bear a heavy burden of HIV in the United States (US). Despite the availability of highly effective daily oral HIV pre-exposure prophylaxis (PrEP), uptake and adherence to PrEP among YMSM remains low. The challenge of taking a daily pill, as well as concerns regarding side effects of the medication, have been identified as reasons for lower than expected uptake of PrEP among youth, and particularly YMSM of color. On-demand, or event-driven, PrEP has been shown to be effective among adult MSM but, to date, has not been examined among YMSM. Data from the extant literature support that YMSM with and without experience with PrEP show interest in exploring different dosing strategies. This interest may translate into greater uptake of PrEP, particularly among those who have expressed unwillingness to try a daily regimen or have not been successful adhering to a daily regimen. While preliminary evidence from adolescent treatment studies suggests that intermittent regimens may be feasible for youth, their ongoing executive function development, coupled with heightened responsiveness to socioemotional contexts, has implications for decision making around sexual behavior and preventative health care. In addition, traits common in adolescents – including impulsivity and sensation seeking - have demonstrated significant and meaningful associations with behaviors that place YMSM at risk for HIV. For these reasons, variable “on demand” strategies may be challenging for youth who are still developing cognitively, and, require developmentally appropriate interventions to maximize their success. While studies of on-demand PrEP strategies have shown that adult MSM have difficulties accurately predicting when sex will occur, this has not been explored among YMSM. The proposed study fills these important gaps in understanding to guide future on-demand PrEP interventions with YMSM. This study will provide insights into potential developmental barriers to on-demand PrEP among YMSM and lay the groundwork for an innovative intervention approach to address them through the completion of three specific aims. Specific Aims 1 and 2 will provide a greater understanding of developmental and cognitive facilitators and barriers to on-demand PrEP. To accomplish these aims, a sample of 120 youth (age 16-24 years) will be recruited and complete a daily electronic diary for 8 weeks to record their predictions of, and actual engagement in, sexual encounters. Surveys conducted at baseline and study completion will measure developmental and sociocultural factors likely to impact prediction of risk (e.g. executive function, impulsivity, planning), and potential intervention approaches (e.g. gist vs. verbatim messages, reward sensitivity). Focus groups conducted in Aim 3 will help to translate findings from Aims 1 and 2 into a just-in-time intervention to increase YMSM's ability to plan for sexual activity and incorporate PrEP dosing based on accurate risk perception. Youth Advisory Board meetings will take place to provide feedback on intervention design.