Expedited Partner Therapy and STI Control for MSM in Peru

描述(由申请人提供)：快速伴侣疗法(EPT)已被证明可以降低异性恋患者持续或复发的淋病和衣原体感染率，但尚未被评估用于男男性行为者(MSM)。CDC指南支持将EPT用于异性患者的伴侣管理，但注意到缺乏必要的证据来对MSM使用EPT提出同等的建议。评估EPT对MSM中伴侣通知、治疗和性传播感染再感染的影响的随机临床试验对于制定循证伙伴管理指南至关重要。我们最近从秘鲁城市获得的数据表明，直肠和咽部淋病和衣原体的患病率从5%到20%不等。秘鲁男男性接触者的疾病负担增加表明，未确诊的淋病和衣原体通过男男性接触者性网络的频繁传播可能是导致该地区男男性接触者感染艾滋病毒的持续高发的一个因素。我们建议对秘鲁在任何解剖部位被诊断为淋病或衣原体感染的MSM进行EPT对伴侣通知和治疗的影响的试点评估。具体目标1：探讨影响秘鲁男男性行为者伴侣通知和治疗的社会规范和结构性因素。具体目标2：确定EPT对被诊断为淋病或衣原体感染的MSM的预期和实际伴侣通知的影响。具体目标3：建立随机接受EPT的MSM中淋球菌和衣原体再感染率的初步数据，并与标准的伴侣通知咨询进行比较。作为一种理论模型，EPT将行为、社会和生物医学方法整合到综合预防干预中，以控制艾滋病毒/性传播感染。我们对伴侣通知和治疗的社会和行为维度的探索将为理解EPT对行为决策过程的影响、影响伴侣通知的人际因素以及秘鲁MSM人群中STI传播的网络模式提供一个方法论结构。我们对淋病和衣原体再感染的生物医学评估将提供初步数据，以支持EPT在MSM人群中控制HIV/STI的权威临床试验的发展。实际问题，包括评估通报和治疗率的方法的评估，确定参与者的性网络的组成(包括参与者网络中无法找到的伴侣的数量)，以及概述在当地环境中实施和评估EPT干预所涉及的后勤问题，所有这些都将有助于制定和完善未来EPT用于MSM控制艾滋病毒/性传播感染的试验。

DESCRIPTION (provided by applicant): Expedited Partner Therapy (EPT) has been shown to reduce rates of persistent or recurrent gonorrhea and chlamydia infection in heterosexual patients, but has not been evaluated for use among men who have sex with men (MSM). CDC guidelines support the use of EPT for partner management with heterosexual patients, but note the absence of evidence necessary to make an equivalent recommendation for the use of EPT with MSM. Randomized clinical trials to assess the impact of EPT on partner notification, treatment, and STI re- infection among MSM are critical to the development of evidence-based partner management guidelines. Our recent data from urban Peru has identified prevalences of rectal and pharyngeal gonorrhea and chlamydia ranging from 5-20%. The elevated burden of disease among MSM in Peru suggests that frequent transmission of undiagnosed gonorrhea and chlamydia through MSM sexual networks may be a factor contributing to the persistently high incidence of HIV infection among MSM in the region. We propose a pilot evaluation of the effect of EPT on partner notification and treatment among MSM in Peru diagnosed with gonorrhea or chlamydia at any anatomic site. Specific Aim 1: To explore the social norms and structural factors influencing partner notification and treatment among MSM in Peru. Specific Aim 2: To determine the effect of EPT on anticipated and actual partner notification among MSM diagnosed with gonorrhea or chlamydia infection. Specific Aim 3: To develop preliminary data on rates of gonococcal and chlamydial re-infection among MSM randomized to receive EPT compared with standard partner notification counseling. As a theoretical model, EPT integrates behavioral, social, and biomedical approaches to HIV/STI control in a comprehensive prevention intervention. Our proposed exploration of the social and behavioral dimensions of partner notification and treatment will provide a methodological structure for understanding the influence of EPT on behavioral decision-making processes, interpersonal factors that influence partner notification, and network patterns of STI transmission within MSM populations in Peru. Our biomedical assessment of gonorrhea and chlamydia re-infection will provide preliminary data to support the development of a definitive clinical trial of EPT for HIV/STI control in MSM populations. Practical issues including an evaluation of methods to assess notification and treatment rates, determination of the composition of participants' sexual networks (including the number of unlocatable partners in participant networks), and an overview of logistical issues involved in implementing and assessing an EPT intervention in the local environment, will all contribute to the development and refinement of a future trial of EPT for HIV/STI control with MSM.