Unified Approach to Address PrEP Cascade for BMSM

生物医学艾滋病毒预防工具非常有前途，但还没有充分地惠及最需要的人。这 R34应用程序请求支持开发一种新的统一模型，以解决PrEP的兴趣，吸收和 与男性发生性关系的黑人男性（BMSM）BMSM的艾滋病毒感染率升高 自美国流行病开始以来，BMSM的发病率和流行率一直在下降，CDC估计， 在一生中被诊断出感染艾滋病毒。在我们目前（非重叠）的工作中，我们记录了一个 BMSM人群中HIV年发病率高达5.1%，HIV流行率高达35%（R01MH 094230， N = 549）。尽管暴露前预防（PrEP）对预防艾滋病毒非常有效，但迫切需要 加强提供PrEP的努力，特别是针对有感染艾滋病毒风险的BMSM。目前增加PrEP的策略 兴趣、吸收和坚持是不够的，并且存在巨大的障碍（例如，柱头周围 PrEP使用，以及依从性和保留问题），以充分覆盖必须解决的PrEP。 如果不对我们目前的PrEP交付方法进行大量有针对性的改变，我们将无法充分 为最需要的人提供PrEP。在我们对BMSM进行的PrEP重点初步研究中，我们已经确定了 需要重点关注和干预的两个主要领域-（1）与PrEP使用相关的耻辱，以及（2）药物 认知，如采取PrEP的感知成本和收益，两者都可能阻碍PrEP的兴趣， 摄取和坚持。为了解决这些问题，我们建议制定一个干预模式， 两个新的认知/行为理论：艾滋病毒污名框架和药物治疗的必要性-关注 框架.具体目标1：对BMSM、社区进行启发式研究 顾问和专家顾问设计一个基于药物的PrEP增强干预措施，用于 有针对性的服务交付设置。具体目标2：将评估PrEP信息传递和干预内容 由社区咨询小组进行评估，并通过开展 干预程序的预试验。具体目标3：进行试点测试，比较PrEP 增强干预（N = 100），包括按需交互式短信，以联系匹配的PrEP 仅信息和性风险咨询控制干预（N = 50）在2，4和6个月的PrEP随访 摄取、坚持和持久性，以确定初步干预效果。 生物医学艾滋病毒预防的进展，如PrEP的可用性，只会影响艾滋病毒的传播。 如果同时努力解决与艾滋病相关的社会和行为挑战， 在艾滋病毒高危人群中实现PrEP的充分覆盖。低资源负担，轻松 实施，有效的社会/行为干预是迫切需要的，如果PrEP的全部好处是， 实现。如果有效并得到推广，这种干预措施将满足当前的预防需求， 对避免艾滋病毒感染可能产生重大影响。

Biomedical HIV prevention tools are very promising, but are not sufficiently reaching those in greatest need. This R34 application requests support to develop a novel, unified model to address PrEP interest, uptake, and adherence among Black men who have sex with men (BMSM). BMSM have experienced elevated rates of HIV incidence and prevalence since the beginning of the US epidemic, and the CDC estimates that half of BMSM will be diagnosed with HIV in their lifetime. In our current (non-overlapping) work, we have documented an exceedingly high 5.1% annual HIV incidence rate and 35% HIV prevalence rate among BMSM (R01MH094230, N=549). Although Pre-Exposure Prophylaxis (PrEP) is highly effective for preventing HIV, there is urgent need to improve efforts to deliver PrEP, in particular, for BMSM at-risk for HIV. Current strategies to increase PrEP interest, uptake, and adherence are not adequate and there are formidable barriers (e.g., stigma surrounding PrEP use, and adherence and retention concerns) to sufficient coverage of PrEP that must be addressed. Without considerable and targeted change to our current approach to PrEP delivery, we will fail to adequately provide PrEP to those in greatest need. In our PrEP focused preliminary studies with BMSM, we have identified two primary areas in need of critical focus and intervention – (1) stigma related to PrEP use, and (2) medication cognitions such as the perceived costs and benefits of taking PrEP, both of which can impede PrEP interest, uptake, and adherence. To address these areas we are proposing to develop an intervention model grounded in two novel cognitive/behavioral theories: the HIV Stigma Framework and the Medication Necessity-Concerns Framework. Our proposed study includes: Specific Aim 1: Conduct elicitation research with BMSM, community advisers, and expert consultants to design an empirically-based PrEP enhancement intervention for use in targeted service delivery settings. Specific Aim 2: PrEP messaging and intervention content will be assessed by a community advisory panel, and intervention feasibility and acceptability will be completed by conducting a pre-pilot test of the intervention procedures. Specific Aim 3: Conduct a pilot test that compares the PrEP enhancement intervention (N=100), including on-demand interactive text messaging, to a contact matched PrEP information only and sexual risk counseling control intervention (N=50) at 2, 4, and 6 month follow-ups on PrEP uptake, adherence, and persistence in order to establish preliminary intervention efficacy. Advances in biomedical HIV prevention, such as the availability of PrEP, will only impact the HIV epidemic if concurrent efforts are made to address the social and behavioral challenges that are associated with achieving sufficient coverage of PrEP among individuals at elevated risk for HIV. Low-resource burden, easily implemented, and effective social/behavioral interventions are urgently needed if the full benefits of PrEP are to be realized. If effective and disseminated, this intervention would meet current prevention needs and its potential impact on HIV infections averted could be substantial.