Building TRUST

 描述(由申请人提供)：建立信任建立在从信任(1R01MH099001)获得的洞察力的基础上，这是一项实施科学研究拨款，发现了高度边缘化的男性的高危男性(MSM)“热点”亚队列，这些男性不成比例地出现在随后几波受访者驱动的抽样(RDS)(作为公共卫生实施工具)中，艾滋病毒感染率高(44%)，临床参与和治疗作为预防(TasP)的接受度低，艾滋病毒和/或性取向的披露水平低，艾滋病毒感染(每100人年13.9人)和性传播感染(性病)(淋病和衣原体)的高发病率表明无保护的肛交，自我网络数据记录了高风险的性定位和低的血清吸毒率，尽管知道艾滋病毒的状况。建立信任假定，在治疗和预防级联中，存在级联特有的人际、网络和结构性障碍，可以通过有针对性的干预来修正(S)，这些障碍可以有利地影响可衡量的效率结果。建立信任，框架在2014年世卫组织重点人群艾滋病毒预防、诊断、治疗和护理综合指南，特别是生物医学预防方法，利用社会生态模型(SEM)纵向收集针对这一“热点”队列的个人、人际和环境数据，并整合创新的系统动力学模型，以获得关于无效预防和治疗结果的驱动因素的基本见解。建立信任的3个目标是：具体目标1：在社会生态模型框架内，探索个人(例如披露)、人际(例如社会/性网络)和环境(例如合法化的污名-反同性恋法律)，以确定在感染艾滋病毒的男男性行为者中有效参与TasP级联的障碍和促进者。结果：对以客观生物标记物(如艾滋病毒病毒载量)为指标的有效参与TasP的障碍有多方面的了解。具体目标2：面对未感染艾滋病毒的男男性行为者对行为改变的接受程度不佳，调查在个人(如感染)、人际(如社会支持、性伴侣)和环境(如社会资本和耻辱)层面引入暴露前预防措施(PrEP)的影响。结果：以客观生物标记物为索引的对有效参与PrEP的障碍的多维理解与来自Aim 1的数据相比较以指导干预策略。具体目标3：通过应用与来自目标1的生物行为和RDS以及自我网络数据相联系的系统动力学流行病学分析，描述男男性接触者社区内艾滋病毒传播网络的特征，以及来自目标2后续行动的未感染艾滋病毒的高危男男性行为者中的艾滋病毒感染事件。结果：加强了对艾滋病毒如何在MSM性网络内和跨性网络传播的理解，从而产生了可操作的干预措施，以阻断前向传播。

 DESCRIPTION (provided by applicant): Building TRUST builds on insights gained from TRUST (1R01MH099001), an implementation science research grant that uncovered a high risk men who have sex with men (MSM) "hotspot" subcohort of highly marginalized men disproportionately represented in later waves of respondent-driven sampling (RDS)(applied as a public health implementation tool) with a high HIV prevalence (44%), low uptake of clinical engagement and treatment as prevention (TasP), low levels of disclosure of HIV and/or sexual orientation, high incidence rates of both HIV infection (13.9 per 100 person- years) and sexually transmitted infections (STI) (gonorrhea and chlamydia) indicative of unprotected anal intercourse, and ego-network data documenting high rates of risky sexual positioning and low rates of serosorting despite knowledge of HIV status. Building TRUST posits that within the treatment and prevention cascade, there are cascade-specific interpersonal, network and structural barriers amendable to targeted intervention(s) that can favorably impact measurable outcomes of efficiency. Building TRUST, framed in the 2014 WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations especially biomedical prevention approaches, employs the Social Ecological Model (SEM) to longitudinally collect individual, interpersonal and environmental data targeting this "hotspot" cohort and integrates innovative phylodynamic modeling to gain fundamental insights about the drivers of ineffective prevention and treatment outcomes. The 3 aims of Building TRUST are: Specific Aim 1: Framed in the Social Ecologic Model, explore individual (e.g. disclosure), interpersonal (e.g. social/sexual network) and environmental (e.g. legalized stigma- antigay laws) to identify barriers and facilitators of effective engagement in the TasP cascade among HIV- infected MSM. Outcomes: A multidimensional understanding of barriers to effective engagement in TasP indexed by objective biomarkers (e.g. HIV viral load). Specific Aim 2: In the face of suboptimal uptake of behavior change among HIV-uninfected MSM, investigate the impact of introducing pre-exposure prophylaxis (PrEP) (newly adopted by the Government of Nigeria) at the individual (e.g. uptake), interpersonal (e.g. social support, sexual partner), and environmental (e.g. social capital and stigma) levels. Outcomes: A multidimensional understanding of barriers to effective engagement in PrEP indexed by objective biomarkers cross compared to data from Aim 1 to guide intervention strategies. Specific Aim 3: Characterize HIV transmission networks within the MSM community by applying phylodynamic epidemiological analyses linked to bio-behavioral and RDS and ego-network data from Aim 1 and among high-risk HIV-uninfected MSM, incident HIV infections from Aim 2 follow-up. Outcomes: Enhanced understanding of how HIV transmission occurs within and across MSM sexual networks leading to actionable interventions tailored to interdict forward transmission.