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

HIV 暴露前预防 (PrEP) 时代的危险行为变化。

• 批准号: 9191301
• 负责人: Kellie Freeborn
• 金额: $ 3.51万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2018-07-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9191301
• 关键词: 18 year old; AIDS prevention; Address; Adherence; Affect; Anal Sex; Attitude; Behavior; Belief; Biological Assay; California; Chlamydia; Clinic; Clinical; Cohort Studies; Contracts; Counseling; Data; Development; Diagnosis; Feasibility Studies; Frequencies; Fright; Fumarates; Gonorrhea; Grant; Growth; HIV; HIV Infections; Health; Health Promotion; Incidence; Individual; Infection; Infection prevention; Interview; Knowledge; Lead; Logistic Regressions; Measures; Mentorship; Modeling; Motivation; National Institute of Nursing Research; Nurses; Oral; Outcome Study; Patient Self-Report; Pattern; Pharmaceutical Preparations; Population; Prevention; Prevention strategy; Prophylactic treatment; Public Health; Published Comment; Research; Research Personnel; Resources; Risk; Risk Behaviors; Safe Sex; Sampling; San Francisco; Services; Sexual Health; Sexually Transmitted Diseases; Statistical Methods; Strategic Planning; Syphilis; Tenofovir; Testing; Time; Toxic effect; Training; United States; Universities; Variant; Work; base; behavior change; behavior influence; cohort; condoms; disorder prevention; emtricitabine; high risk; high risk behavior; improved; information gathering; men who have sex with men; pill; pressure; prevent; primary outcome; programs; prospective; psychologic; secondary outcome; sex; sex risk; sexual health intervention; skills; social; social media; social norm; statistics; theories; tool; transmission process; trend; truvada; web site

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.

项目摘要 这项前瞻性临床队列研究将检验暴露前预防艾滋病病毒(PrEP)之间的关系。 男性患者开始使用避孕套和随后的性传播感染(STI)模式 男男性性行为(MSM)。队列由大约600名18岁及以上的MSM组成，他们发起PrEP并接受 旧金山一家性健康诊所的服务将每季度跟踪一次，为期12个月。准备，在 特鲁瓦达®是一种每日一次的药片，使用简单，毒性低，在降低艾滋病毒感染风险方面效果良好。虽然预防艾滋病方案解决了预防艾滋病毒传播的问题，但它没有提供任何预防其他性传播感染的保护措施，男男性行为者不成比例地受到性传播感染的影响，在这一人群中，这一比例继续上升。这项研究将调查服用PrEP的MSM高危人群中避孕套使用的变化和性传播疾病。它将提供关于潜在的疾病预防战略和健康促进信息的信息，其中包括社会和个人对安全性行为的影响。在这项研究中，性脚本理论和理性行为理论将被作为一个框架来指导理解社会和个人对MSM自愿危险行为和性行为的影响。这项研究的目的是：1)检验一组男男性接触者在实施PrEP前的危险行为水平与启动PrEP后12个月以上的行为之间的关系；2)确定避孕套使用的变化并检查变化的原因；3)通过生物测定来测量性传播感染的频率和类型，以确定正在启动PrEP的MSM的危险行为的变化。在频率和描述性分析完成后，将使用多水平Logistic回归模型来预测PrEP开始前后的危险行为与人口统计学变量的关联。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，以便不仅了解平均变化，还了解个体差异。将对10-20人进行定性访谈，以丰富我们对可能影响避孕套使用的社会影响和个人动机的知识和理解。这项研究将收集PrEP使用者的社会人口学数据，他们使用PrEP的原因，以及社会、心理和行为对避孕套使用的影响，以及在PrEP健康计划的真实世界实施期间STI的后续变化。这项研究收集的信息将填补关于使用PrEP、避孕套使用和性传播感染的MSM的知识空白。为开展男男性接触者PrEP性健康干预，改善避孕套使用行为，降低性病感染率奠定了基础。这项研究将在我的跨学科指导团队的支持和专业知识的支持下完成。波蒂略、卡里科、博耶、米洛-桑托斯博士在性健康、男男性接触者、风险行为、统计方法、定性和定量研究方面拥有广泛的高级知识，并致力于我作为护士研究员的成功培训。