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A New Approach to Integrating Primary and Secondary HIV Prevention in Young Male Couples

年轻男性夫妇艾滋病毒一级和二级预防一体化的新方法

基本信息

批准号：
9179853
负责人：
Michael E Newcomb
金额：
$ 231.75万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-06-01 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9179853
关键词：
AIDS prevention Accounting Address Adolescent and Young Adult Alcohol consumption Alcohol or Other Drugs use Anus Behavioral Caring Chlamydia Counseling Coupled Couples Drug usage Enrollment Fatigue Goals HIV HIV Infections HIV risk Heterosexuals Human immunodeficiency virus test Incidence Individual Infection Intervention Intervention Studies Learning Life Measures Mediator of activation protein Mental health promotion Modality Outcome Prevention Prevention approach Prevention strategy Primary Prevention Prophylactic treatment Public Health Practice Randomized Relative Risks Reporting Research Risk Risk Behaviors Risk Reduction Secondary Prevention United States National Institutes of Health Viral Load result base behavioral health behavioral outcome comparative effectiveness design efficacy testing improved innovation male medication compliance men men who have sex with men novel strategies physical conditioning pilot trial post intervention prevent programs racial diversity secondary outcome sex transmission process uptake young men who have sex with men

项目摘要

Project Summary Adolescent and young adult men who have sex with men (YMSM) are the only group in the U.S. where rates of new HIV infections are increasing, which reflects a large disparity relative to heterosexuals. Steady or main partner relationships account for a substantial proportion of new HIV infections in YMSM. Among YMSM a serious relationship status is perhaps the strongest predictor of condomless anal intercourse (CAI), and pre- exposure prophylaxis (PrEP) may also be discontinued in a relationship. Alcohol and drug use are important influences on HIV risk in YMSM, particularly in serious relationships. Romantic relationships also provide myriad benefits, including promotion of mental, behavioral, and physical health. Despite the critical importance of romantic relationship factors for HIV prevention, the vast majority of studies and interventions focus on individuals. My research team and I conducted formative research on coupled YMSM through an NIH R21 from which I developed an innovative couples-based intervention that addresses the continuum of HIV prevention and care for YMSM couples. The 2GETHER program integrates couples- and group-based modalities and is innovative in its design to address HIV transmission risk in couples regardless of serostatus; couples learn to utilize behavioral and biomedical approaches to prevent both HIV acquisition and transmission, with an overarching emphasis on improving relationship functioning. 2GETHER further encourages uptake of couples- based HIV testing for HIV-/unknown YMSM and addresses medication adherence and barriers to care for HIV+ YMSM. I established feasibility, acceptability and preliminary efficacy 2GETHER in a pilot trial of coupled YMSM (N=52 couples; 104 individuals), including significant decreases in HIV transmission risk behavior. My pilot focused primarily on prevention of risk behavior, and given its highly promising effects, I now take an important scientific risk to also evaluate its effects on engagement in care. I propose to test the efficacy of 2GETHER in a comparative effectiveness RCT relative to existing public health practice (PHP). I will: (a) enroll racially diverse coupled YMSM; (b) randomize couples to either the 2GETHER intervention or PHP (couples voluntary HIV counseling and testing for HIV- YMSM; Life-Steps HIV medication adherence for HIV+ YMSM); (c) measure intervention outcomes through 12 months post-intervention. Primary behavioral outcome: an individual-level transmission risk variable for both HIV+/- men calculated based on relative risk of sex acts (a traditional CAI outcome will also be examined). Primary biomedical outcome: Chlamydia/Gonnorhea incidence. Secondary outcomes: HIV incidence and HIV testing uptake (HIV- men), viral load (HIV+ men), and substance use problems and relationship functioning as these are mediators of HIV risk. In the context of increasing fatigue for HIV prevention, I believe a healthy relationships program for coupled YMSM presents an opportunity to reinvigorate HIV prevention. Further, in the era of treatment as prevention, we must develop transmission prevention strategies for MSM regardless of serostatus that address the full continuum of prevention and care.

项目摘要青春期和青壮年男男性行为者(YMSM)是美国唯一一个新的艾滋病毒感染人数正在增加，这反映了相对于异性恋者的巨大差距。稳定或主要在基督教青年会新感染艾滋病毒的患者中，伴侣关系占很大比例。在基督教青年会中，严重的关系状况可能是无套肛交(CAI)的最强预测因子，而Pre-Pre 在一段关系中，暴露预防(PrEP)也可以停止。酗酒和吸毒很重要对青年男性接触者的艾滋病毒风险的影响，特别是在认真的关系中。浪漫的关系也提供了好处多多，包括促进心理、行为和身体健康。尽管重要的是关于恋爱关系因素对艾滋病毒预防的影响，绝大多数研究和干预都集中在个人。我和我的研究团队通过NIH R21对耦合YMSM进行了形成性研究我开发了一种创新的以夫妻为基础的干预措施，解决了艾滋病毒预防的连续体并关爱基督教青年会夫妇。2gether计划集成了基于夫妇和基于群体的医疗模式，并其设计创新，以解决夫妇之间的艾滋病毒传播风险，无论血清状态；夫妇学习利用行为和生物医学方法预防艾滋病毒感染和传播，最主要的重点是改善关系运作。2gether进一步鼓励夫妻之间的相互接纳- 基于HIV-/未知YMSM的HIV检测，并解决药物依从性和护理HIV+的障碍基督教青年会。我在一项联合试验中确定了可行性、可接受性和初步疗效。 YMSM(N=52对夫妇；104人)，包括艾滋病毒传播危险行为显著减少。我的 Pilot主要专注于预防风险行为，鉴于其非常有希望的效果，我现在采取一个重要的科学风险也要评估其对护理参与度的影响。我建议测试一下 2与现有公共卫生实践(PHP)相比，RCT的有效性更高。我会：(A)注册 (B)将夫妇随机分为2gether干预组或php组(夫妇 HIV-YMSM自愿艾滋病毒咨询和检测；HIV+YMSM的生命步骤艾滋病毒用药依从性)； (C)通过干预后12个月衡量干预结果。主要行为结果：根据性行为(A)的相对风险计算的HIV+/-男性的个人水平传播风险变量还将审查传统的计算机辅助教学成果)。主要生物医学结果：衣原体/弓形虫发病率。次要结果：艾滋病毒发病率和艾滋病毒检测吸入率(艾滋病毒-男子)、病毒载量(艾滋病毒+男子)和物质使用问题和人际关系发挥作用，因为它们是艾滋病毒风险的调解人。在不断增加的背景下疲惫的HIV预防，我相信为夫妻YMSM提供了一个健康的关系计划提供了一个机会重振艾滋病毒预防工作。此外，在治疗即预防的时代，我们必须发展传播。针对男男性接触者的预防策略，无论其血清状态如何，都涉及到预防和护理的全过程。