Building TRUST

 描述（申请人提供）：建立信任建立在从信任中获得的见解之上（1 R 01 MH 099001），一项实施科学研究资助，发现了一个高风险的男性与男性发生性关系（MSM）的“热点”子队列，高度边缘化的男性在后来的应答者驱动抽样（RDS）浪潮中不成比例地代表（作为公共卫生实施工具），艾滋病毒流行率高（44%），临床参与和治疗作为预防（TasP）的接受率低，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性体位率和低血清学分类率，尽管艾滋病毒状况的知识。建立信任假设在治疗和预防级联中，有级联特定的人际，网络和结构性障碍，可以有针对性的干预措施，可以有利地影响可衡量的效率结果。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，框架内的建立信任，采用社会生态模型（SEM）纵向收集个人，针对这一“热点”的人际和环境数据队列并整合创新的动态建模，以获得有关无效预防和治疗驱动因素的基本见解结果。建立信任的三个目标是：具体目标1：在社会心理学模型中，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），以确定艾滋病毒感染的男男性行为者有效参与TasP级联的障碍和促进因素。结果：通过客观生物标志物（例如HIV病毒载量）索引，对有效参与TasP的障碍进行多维理解。具体目标二：面对未感染艾滋病毒的男男性行为者对行为改变的次优吸收，调查引入暴露前预防（PrEP）（尼日利亚政府新采用）在个人（例如吸收）、人际（例如社会支持、性伴侣）和环境（例如社会资本和耻辱）层面的影响。成果：通过与目标1的数据进行交叉比较，对有效参与PrEP的障碍进行多维理解，以指导干预策略。具体目标3：通过应用与目标1的生物行为和RDS以及自我网络数据相关联的动态流行病学分析，以及目标2随访的高风险未感染HIV的MSM、事件HIV感染者之间的动态流行病学分析，表征MSM社区内的HIV传播网络。成果：加强对艾滋病毒传播如何在男男性行为者性网络内部和之间发生的了解，从而采取针对性的可采取行动的干预措施，以阻断向前传播。

 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.