START: Study of Trauma and Reduction of HIV Transmission

 描述(申请人提供)：背景：START是一项关于创伤和减少艾滋病毒传播的研究，是一项横断面研究，将调查创伤应激是否有助于在使用兴奋剂的男男性行为者(MSM)中导致“潜在放大传播”(PAT)危险行为(可检测到的艾滋病毒载量和艾滋病毒传播风险共存)。使用兴奋剂的男男性接触者受艾滋病毒的影响最大，尽管抗逆转录病毒疗法(ART)已得到广泛应用。1“治疗即预防”(TasP)的定义是扩大获得抗逆转录病毒疗法的途径以实现持续的病毒抑制，这是一种将被利用的很有前途的生物医学预防方法。虽然文献支持早期开始抗逆转录病毒治疗可降低艾滋病毒传播率，但使用兴奋剂的男男性接触者被排除在这些里程碑式的试验之外。众所周知，使用兴奋剂的男男性接触者在艾滋病毒相关护理中的使用率和参与度较低，从而导致更高的病毒载量和更高的艾滋病毒传播率。2这项拟议研究的主要目标是确定与以下因素相关的可改变的风险因素 PAT为创新的、以理论为基础的干预措施的发展提供信息，以优化TasP在使用兴奋剂的MSM中的有效性。由此产生的信息将为艾滋病毒/艾滋病预防方法的发展提供信息，以提高TasP在使用兴奋剂的MSM中的有效性，从而降低艾滋病毒传播率。 与培训有关：本提案旨在提供深入的研究培训。将进行通径分析，以了解心理社会因素在创伤应激与帕金森病之间的关系中所起的作用。这一结果将为K99/R00赠款的准备提供初步数据，该赠款将用于开发和试点一种行为干预措施，以减少使用兴奋剂的MSM中的创伤应激症状和艾滋病毒传播。这项F31提案是成为独立护士调查员的合乎逻辑的一步。创新：这项研究在三个方面是创新的。首先，将利用共同出现的结果变量PAT来建模 第二，将探索心理社会因素在创伤应激和创伤后应激障碍之间关系中的潜在中介作用；第三，将利用新技术，包括(A)气球模拟风险任务(BART)测量冲动，同时消除需要自我洞察和意识的自我报告测量的限制，以及(B)音频计算机辅助自我访谈(ACASI)，用于行为研究，以最大限度地减少回忆和社会期望偏差，并增强自我报告的准确性，从而增加内部和外部 有效性。

 DESCRIPTION (provided by applicant): Background: START, a Study of Trauma and Reduction of HIV Transmission, is a cross-sectional study that will examine whether traumatic stress contributes to "potentially amplified transmission" (PAT) risk behavior (the co-occurrence of detectable HIV viral load and HIV transmission risk) among stimulant-using men who have sex with men (MSM). Stimulant-using MSM are most heavily affected by HIV, despite the widespread availability of antiretroviral therapy (ART).1 "Treatment as Prevention" (TasP), defined as expanded ART access to achieve sustained viral suppression, is a promising biomedical prevention approach that will be utilized. While literature supports that early ART initiation decreases HIV transmission rates, stimulant-using MSM were excluded from these landmark trials. Stimulant-using MSM are known for low utilization and low engagement in HIV-related care thereby resulting in higher viral loads and high HIV transmission rates.2 The overarching objective of this proposed study is to identify modifiable risk factors associated with PAT to inform the development of innovative, theory-based interventions to optimize the effectiveness of TasP in stimulant-using MSM. Resulting information will inform the development of HIV/AIDS prevention approaches enhancing the effectiveness of TasP in stimulant-using MSM, thereby decreasing HIV transmission rates. Relation to Training: This proposal is designed to provide in-depth research training. Pathway analysis will be conducted to understand the role of psychosocial factors in the relationship between traumatic stress and PAT. The results will provide preliminary data for the preparation of a K99/R00 grant, which will be used to develop and pilot test a behavioral intervention to reduce traumatic stress symptoms and HIV transmission in stimulant- using MSM. This F31 proposal is a logical step in becoming an independent nurse investigator. Innovation: The study is innovative in three ways. First, PAT, a co-occurring outcome variable, will be utilized to model an outcome most closely linked with high HIV-viral transmission efficiency; second, the potential mediational role of psychosocial factors in the relationship between traumatic stress and PAT will be explored; and third, novel techniques will be utilized, including (a) the Balloon Analogue Risk Task (BART) measure of impulsivity while eliminating the limitation of a self-report measure requiring self-insight and awareness, and (b) Audio Computer Assisted Self Interviewing (ACASI), which is used in behavioral research to minimize recall and social desirability bias and enhance the veracity of self-report, thereby increasing internal and external validity.