Comprehensive HIV Prevention Package for MSM in Southern Africa

描述（由申请人提供）：本申请的总体目标是为南部非洲的男男性行为者（MSM）开发一个优化的艾滋病毒预防服务组合包，开发有关候选包的可接受性的初步数据，并为随后的预防包的有效性试验制定合理的建议。这项研究的基本原理很简单：几乎没有工作，无论是在研究领域还是在规划领域，都关注于南部非洲地区男男性行为者的艾滋病毒预防干预——尽管有新证据表明艾滋病毒正在这些男性中严重流行。男男性行为者社区开始在南部非洲出现，而且是在世界上艾滋病毒流行最严重和最普遍的背景下出现的。非洲男男性行为者仍然是艾滋病毒流行风险最隐蔽和最受歧视的群体之一，对他们来说，适合当地环境的优化预防方案是公共卫生和研究的紧迫优先事项。我们的团队在马拉维、纳米比亚、博茨瓦纳、莱索托进行了首例男男性行为的流行病学研究，并在开普敦城郊的非洲人和有色人种男男性行为群体中进行了首次此类研究。这些研究产生了如何在这些充满挑战的环境中安全地进行艾滋病毒研究的专业知识，并证明了与男同性恋者和LGBT社区组织合作在成功开展这项急需的研究方面的首要作用。我们将利用这一专业知识，通过以下四项具体举措，制定我们优化的艾滋病毒预防方案：对南部非洲男男性行为、生物医学和结构干预方面的文献进行全面审查；建立一个数学模型，考虑与男性发生性行为、与女性发生性行为、包皮环切状况、插入率、抗逆转录病毒药物使用和风险环境，以估计实施行为、生物医学和社区一级一揽子干预措施对艾滋病毒传播的影响；在赞比亚卢萨卡和南非开普敦周围的2个以黑人为主的城镇进行一揽子预防措施的可接受性和可行性试点研究；并利用试点研究的初步信息，设计一项更大、更明确的预防方案有效性研究

DESCRIPTION (provided by applicant): The overarching aim of this application is to develop an optimized combination package of HIV prevention services for men who have sex with men (MSM) in southern Africa, to develop preliminary data about the acceptability of the candidate package, and to develop a rational proposal for a subsequent efficacy trial of the prevention package. The rationale for this study is simple: virtually no work, in either research or programmatic areas, has focused on HIV preventive interventions for MSM in the Southern African region-despite emerging evidence that a severe epidemic of HIV is underway among these men. Communities of MSM are beginning to emerge in Southern Africa and they are doing so in the context of the world's most advanced and generalized epidemic of HIV. African MSM remain among the most hidden and stigmatized groups at risk in the HIV epidemic, and one for whom optimized prevention packages, fit to challenging local environments, are an urgent public health and research priority. Our group has conducted the first epidemiologic studies of MSM in Malawi, Namibia, Botswana, Lesotho and the first such studies among African and Colored MSM communities in peri-urban Cape Town. These studies have yielded expertise in how to safely conduct HIV research in these challenging environments, and have demonstrated the primacy of partnership with MSM and LGBT community organizations in the successful conduct of this critically needed research. We will use this expertise to develop our optimized HIV prevention package through four specific initiatives: conducting an umbrella review of literature on behavioral, biomedical, and structural interventions for MSM in Southern Africa; developing a mathematical model that accounts for sex with men, sex with women, circumcision status, insertivity ratios, ARV use, and the risk environment to estimate the impact on HIV transmission of implementation of a package of behavioral, biomedical, and community-level interventions; conducting pilot studies of acceptability and feasibility of the prevention package in Lusaka, Zambia and 2 predominately (black) African townships surrounding Cape Town, South Africa; and using preliminary information from the pilot study to design a larger, definitive study of the efficacy of the prevention package PUBLIC HEALTH RELEVANCE: Men who have sex with men in Africa are a largely hidden population at tremendous risk of HIV infection. This study proposes to use a process of review of existing knowledge and literature and mathematical modeling to develop a package of HIV prevention interventions for MSM in Africa, and to pilot test the acceptability of the package in Lusaka, Zambia and Cape Town, South Africa.