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

项目摘要 在美国，青少年和男男性行为者(YMSM)携带着沉重的艾滋病毒负担 州(美国)。尽管有高效的每日口服艾滋病毒暴露前预防(PrEP)，但 青年男性接触者对PrEP的依从性仍然很低。每天服用避孕药的挑战以及担忧 关于药物的副作用，已被确定为摄取量低于预期的原因 在年轻人中做准备，特别是有色人种的YMSM。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，但到目前为止，尚未在青年男性接触者中进行检测。现存文献中的数据 对有和没有PrEP经验YMSM的支持显示出对探索不同剂量的兴趣 战略。这种兴趣可能会转化为对PrEP的更大接受，特别是在那些 表示不愿尝试每日养生法，或坚持每日养生法并不成功。而当 来自青少年治疗研究的初步证据表明，间歇疗法可能对 青年，他们正在进行的执行功能发展，加上对 社会情感背景，对围绕性行为和预防性健康的决策有影响 关心。此外，青少年的共同特征--包括冲动和寻求感觉--有 研究表明，将青年男性接触者置于艾滋病毒风险中的行为与其有显著和有意义的关联。为 由于这些原因，可变的“随需应变”战略对仍在发展中的青年来说可能是一种挑战 在认知上，和，需要发展适当的干预措施，以最大限度地取得成功。在研究的同时 按需PrEP策略表明，成年男男性行为者很难准确预测性行为何时发生 虽然发生了这种情况，但在基督教青年会中还没有对此进行探索。拟议的研究填补了以下方面的重要空白 了解以指导未来对基督教男同性恋者按需进行PrEP干预。这项研究将为 在基督教青年会中按需提供PrEP的潜在发展障碍，并为创新 采取干预方法，通过完成三个具体目标来解决这些问题。具体目标1和2将 更好地了解发展和认知促进因素以及按需预习的障碍。 为了实现这些目标，将招募120名青年(16-24岁)，并完成每日一次的 为期8周的电子日记，记录他们对性行为的预测和实际参与。 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(例如执行功能、冲动、计划)和潜在干预 方法(例如，主旨消息与逐字消息、奖励敏感性)。在AIM 3中开展的焦点小组将有助于 将AIMS 1和AIMS 2的调查结果转化为及时干预，以提高YMSM的计划能力 性行为和纳入PrEP剂量基于准确的风险感知。青年顾问委员会 将举行会议，就干预设计提供反馈。

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.