Comprehensive HIV Prevention Package for MSM in Southern Africa

说明(由申请人提供)：本申请的总体目标是为南部非洲男男性行为者(MSM)开发艾滋病毒预防服务的优化组合方案，开发关于候选方案可接受性的初步数据，并为预防方案的后续疗效试验制定合理的建议。这项研究的理由很简单：无论是在研究领域还是在规划领域，几乎没有一项工作侧重于对南部非洲地区男男性接触者进行艾滋病毒预防干预--尽管有新的证据表明，艾滋病毒在这些男子中正在严重流行。男男性接触者社区开始在南部非洲出现，他们是在世界上最先进和最普遍的艾滋病毒流行的背景下这样做的。非洲男男性接触者仍然是艾滋病毒流行中最隐蔽和最受羞辱的群体之一，对他们来说，优化的预防方案，适合具有挑战性的当地环境，是紧迫的公共卫生和研究优先事项。我们小组在马拉维、纳米比亚、博茨瓦纳、莱索托进行了第一次男男性接触者流行病学研究，并在开普敦郊区的非洲和有色人种男男性接触者社区中进行了第一次此类研究。这些研究在如何在这些具有挑战性的环境中安全地进行艾滋病毒研究方面取得了专门知识，并证明了与MSM和LGBT社区组织的伙伴关系在成功开展这项迫切需要的研究方面的首要地位。我们将利用这一专业知识，通过四项具体举措来制定我们优化的艾滋病毒预防方案：对南部非洲MSM的行为、生物医学和结构性干预的文献进行总括审查；开发一个数学模型，说明男男性行为、女性性行为、包皮环切状况、插入比率、抗逆转录病毒的使用和风险环境，以估计实施一整套行为、生物医学和社区一级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2个以黑人为主的非洲城镇开展预防方案的可接受性和可行性的试点研究；并利用试点研究的初步信息，设计一项关于预防一揽子计划有效性的更大、更明确的研究

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