Risk Behavior Changes in the Era of Pre-exposure Prophylaxis (PrEP) for HIV.

项目摘要 这项前瞻性临床队列研究将检查HIV暴露前预防（PrEP） 男性使用避孕套和性传播感染的开始和随后的模式 男同性恋（MSM）该队列包括约600名18岁及以上的MSM，他们启动PrEP并接受 从旧金山弗朗西斯科的一家性健康诊所获得的服务，将每季度进行一次，为期12个月。PrEP，在 Truvada®是一种每日一次的药丸，使用简单，毒性低，在降低艾滋病毒感染风险方面效果良好。虽然PrEP解决了预防艾滋病毒传播的问题，但它并没有提供任何预防其他性传播感染的保护，MSM受到性传播感染的影响，并且在这一人群中的发病率继续增加8 -10。本研究将探讨安全套使用的变化和性传播感染的高危人群的男男性接触者服用PrEP。它将提供潜在的疾病预防策略和健康促进信息，包括社会和个人对安全性行为的影响。本研究将以性脚本理论和理性行为理论为框架，探讨社会和个体因素对男男性接触者自愿冒险行为和性行为的影响。本研究的目的是：1）检查MSM人群在开始PrEP之前的危险行为水平与开始PrEP后12个月内的危险行为之间的关联; 2）确定安全套使用的变化并检查变化的原因; 3）确定正在开始PrEP的MSM中危险行为的变化，使用生物测定法测量STI的频率和类型。在完成频率和描述性分析后，将使用多水平logistic回归模型预测PrEP开始前后风险行为与人口统计学变量的相关性。潜在变量增长模型（LGM）将被用来描述避孕套使用和性传播感染的增长曲线，以了解不仅是平均变化，而且个体差异。将对10-20人的样本进行定性访谈，以丰富我们对可能影响安全套使用的社会影响和个人动机的知识和理解。这项研究将捕获PrEP用户之间的社会人口学数据，他们使用PrEP的原因，以及社会，心理和行为对安全套使用的影响，以及在PrEP健康计划的现实世界实施过程中STI的后续变化。这项研究收集的信息将填补关于MSM使用PrEP，安全套使用和性传播感染的知识空白。本研究将为制定针对MSM人群的PrEP性健康干预措施，以改善安全套使用行为，降低性病发病率奠定基础。这项研究将在我的跨学科导师团队的支持和专业知识下完成。Portillo，Carrico，Boyer，Milo-Santos在性健康，MSM，风险行为，统计方法，定性和定量研究方面拥有广泛的先进知识，并致力于我作为护士研究员的成功培训。

Project Summary This prospective clinical cohort study will examine the association of HIV pre-exposure prophylaxis (PrEP) initiation and subsequent patterns of condom-use and sexually transmitted infections (STIs) in men who have sex with men (MSM). The cohort, comprising ~ 600 MSM, 18 years and older, who initiate PrEP and receive services from a sexual health clinic in San Francisco, will be followed quarterly for 12 months. PrEP, in the form of Truvada®, is a once daily pill, which is simple to use with low toxicity and good efficacy in reducing the risk of HIV acquisition. While PrEP addresses protection against HIV transmission, it does not provide any protection against other STIs, MSM are disproportionally affected by STIs, and rates continue to increase in this population8-10. This study will examine condom-use change and STIs in a high risk population of MSM taking PrEP. It will provide information on potential disease prevention strategies and health promotion messages that encompass social and individual influences on safe sex practices. In this study, the theories of Sexual Scripting and Reasoned Action will be used as a framework to guide the understanding of the social and individual influences on voluntary risk behavior and sexual practices among MSM. The aims of this study are: 1) To examine the associations between levels of risky behaviors in a cohort of MSM prior to initiating PrEP versus those behaviors over 12 months subsequent to initiating PrEP; 2) To identify changes in condom use and examine reasons for change; and 3) To determine changes in risk behaviors in MSM who are initiating PrEP using biological assays to measure the frequency and type of STIs. After frequencies and descriptive analyses are completed, multilevel logistic regression models will be used to predict the associations of risk behaviors before and after initiation of PrEP with demographic variables. Latent variable growth modeling (LGM) will be utilized to describe growth curves for condom use and STIs in order to understand not only the average change but also individual variations. Qualitative interviews will be conducted with a sample of 10-20 individuals to enrich our knowledge and understanding of the social influences and individual motivations that may be affecting condom-use. This study will capture sociodemographic data among PrEP users, their reasons for using PrEP, and the societal, psychological and behavioral influences on condom use and subsequent changes in STIs during a real-world implementation of a PrEP health program. Information gathered in this research will fill a knowledge gap on MSM using PrEP, condom-use and STIs. It will lay the foundational work for the development of a sexual health intervention for MSM on PrEP in order to improve condom use behavior and decrease STI rates. This study will be completed with the support and expertise from my interdisciplinary mentorship team. Drs. Portillo, Carrico, Boyer, Milo-Santos have a wide range of advanced knowledge in sexual health, MSM, risk behavior, statistical methods, qualitative and quantitative research and are committed to my successful training as a nurse researcher.