STI Screening as a Combined HIV Prevention Platform for MSM in Peru

 描述(由申请人提供)：直肠性传播感染(STI)的定期咨询、检测和治疗为秘鲁男男性行为者(MSM)提供了一个整合行为和生物艾滋病毒预防策略的多维平台。淋病和衣原体等直肠性传播疾病是MSM感染HIV的关键风险因素，既是最近无保护的接受性肛交(URAI)的间接行为标志，也是增加HIV共同传播的细胞风险的炎症因素。然而，还没有针对与直肠STI传播相关的特定行为和生物学风险因素或将直肠GC/CT筛查与其他预防服务相结合对艾滋病毒传播风险的潜在影响的干预措施的前瞻性研究。我们将使用核酸测试对750名行为高危男男性接触者进行直肠淋病和/或衣原体(GC/CT)感染的筛查。GC/CT阳性的受试者将接受单次抗生素治疗和单次个人认知咨询(PCC)(n=50)或标准测试后咨询(n=50)。GC/CT阴性对照组(n=50)也将被纳入比较生物学结果，包括直肠STI后炎性细胞因子水平的变化。目的1：使个性化认知咨询(PCC)模式适用于秘鲁的MSM。目的2：调整和预试SJEI和行为评估工具，用于秘鲁的MSM。目的3：在秘鲁对男男性接触者进行基于直肠性传播感染咨询、检测和治疗的HIV联合预防干预试验。评估干预措施的可行性/可接受性、GC/CT患病率/再感染率以及对 将使用HIV感染的行为和生物介体来规划直肠性传播感染监测作为秘鲁男男性行为者HIV预防的R01评估。

 DESCRIPTION (provided by applicant): Periodic counseling, testing, and treatment for rectal sexually transmitted infections (STIs) provides a multi- dimensional platform to integrate behavioral and biological HIV prevention strategies for men who have sex with men (MSM) in Peru. Rectal STIs like gonorrhea and chlamydia are key risk factors for HIV acquisition among MSM, both as indirect behavioral markers of recent unprotected receptive anal intercourse (URAI), and as inflammatory factors that increase cellular risk for HIV co-transmission. However, there have been no prospective studies of interventions addressing the specific behavioral and biological risk factors associated with rectal STI transmission or the potential impact on HIV transmission risk of integrating rectal GC/CT screening with other prevention services. We will use nucleic acid testing to screen 750 behaviorally high-risk MSM for rectal gonorrheal and/or chlamydial (GC/CT) infection. GC/CT-positive subjects will receive single- dose antibiotic treatment and either single-session Personal Cognitive Counseling (PCC) (n=50) or standard post-test counseling (n=50). A GC/CT-negative control group (n=50) will also be enrolled to compare biological outcomes including changes in levels of inflammatory cytokines following rectal STI. Aim 1: To adapt a Personalized Cognitive Counseling (PCC) model for use with MSM in Peru. Aim 2: To adapt and pre-test the SJEI and behavioral assessment instruments for use with MSM in Peru. Aim 3: To pilot a combined HIV prevention intervention based on rectal STI counseling, testing, and treatment for MSM in Peru. Estimates of feasibility/acceptability of the intervention, GC/CT prevalence/re-infection rate and the effect on behavioral and biological mediators of HIV infection will be used to plan an R01 evaluation of rectal STI surveillance as HIV prevention for MSM in Peru.