Feasibility of Short-Term PrEP Uptake for MSM with Episodic High-Risk for HIV

 描述(由申请人提供)：这项拟议的研究旨在调查男男性行为者(MSM)对HIV预防的短期间歇性暴露前预防措施的可接受性、感知需要和接受程度。对于许多没有感染艾滋病毒的男性来说，长期的PrEP可能是不必要的，他们有断断续续的背景定义的高危期，特别是当他们离开家的时候。对于大多数MSM来说，替代剂量策略，如短期固定间隔发作性PrEP(Epi-PrEP)，可能是一种更现实、更可行、更可接受和更有用的选择，对公共健康有很高的影响。如果正确使用和传播，PREP有可能极大地提高当前艾滋病毒预防工作的有效性。这项申请旨在调查几个问题，对开发有效的Epi-PrEP摄取和依从性计划至关重要。拟议的两个城市(匹兹堡和波士顿)研究的具体目的是：(1)描述和评估具有高风险但短期的MSM的流行率，此时发作性PrEP可能是一种最佳的HIV预防策略，特别关注SES低的男性；(2)确定在诊所为基础的EPI-PrEP实施试点项目的可行性，这些MSM报告偶尔发生无保护措施的性行为，并预计他们在研究期间将在规定的高危时间发生；以及(3)确定与坚持相关的具体背景和问题，以及弹性，这将为更大规模的Epi-PrEP有效性试验的干预设计提供信息。这项研究的结果将为在更大规模的有效性试验中支持Epi-PrEP依从性干预的设计、实施和评估提供必要的经验平台。通过基于衡量高危MSM中Epi-PrEP使用情况的数据创建新的干预策略，我们可以帮助确保PrEP策略将减少占美国所有新增HIV感染人数近三分之二的风险群体中的HIV传播。

 DESCRIPTION (provided by applicant): This proposed study is designed to investigate the acceptability, perceived need and uptake of short-term episodic Pre-Exposure Prophylaxis for HIV prevention among men who have sex with men (MSM). Long-term PrEP may be unnecessary for the many HIV-uninfected men who have episodic contextually defined high-risk periods, particularly when away from their home setting. Alternative dosing strategies, such as short-term fixed-interval episodic PrEP (Epi-PrEP), may be a more realistic, feasible, acceptable, and useful option with high public health impact for the majority of MSM. PrEP has the potential to dramatically raise the effectiveness of current HIV prevention efforts if it is correctly used and disseminated. This application is designed to investigate several questions essential to the development of efficacious Epi-PrEP uptake and adherence programs. The specific aims of the proposed two-city (Pittsburgh and Boston) study are to: (1) characterize and assess the prevalence of MSM who have high-risk but short-term periods when episodic PrEP may be an optimal HIV prevention strategy with a particular focus on low SES men; (2) determine the feasibility of clinic- based Epi-PrEP implementation pilot project for MSM who report occasional unprotected sex and who anticipate that they will have at defined high-risk time during the study period; and (3) Identify specific adherence-related contexts and problems, as well as resiliencies that will inform the intervention design of a larger scale trial of the effcacy of Epi-PrEP. Findings from this study will provide the empirical platform necessary to supporting the design, implementation and evaluation of an Epi-PrEP adherence intervention in a larger scale effectiveness trial. By basing the creation of new intervention strategies on data that measure both uptake and adherence of Epi-PrEP use among high-risk MSM, we can help ensure that PrEP strategies will reduce HIV transmission among the risk group that accounts for nearly two-thirds of all new HIV infections in the U.S.