Training in MHealth Prevention with MSM

摘要 马来西亚艾滋病毒流行正在迅速扩大，最近的证据表明，性行为加速 传播，特别是在男男性行为者(MSM)中：2008年为10%，2016年为54%。生物行为 调查显示，全国(21.6%)和吉隆坡(43%)男男性接触者中艾滋病毒感染率很高。这一增长 MSM流行与无公寓性行为(CS)、性传播感染和大量使用物质有关(特别是 苯丙胺类兴奋剂；安非他明类兴奋剂)。在马来西亚，吸毒和同性恋都被定为刑事犯罪， 使男男性接触者双重承担社会耻辱和歧视的负担，包括在医疗保健领域。因此， 他们被排斥在传统的、以场所为基础的艾滋病毒预防服务之外，这破坏了 国际机构的建议。为了解决耻辱和歧视问题，mHealth(移动技术 为了促进健康)战略可以匿名地传递预防信息和指导健康决策，因此 为MSM带来巨大的希望，特别是那些使用ATS的人。他们可以克服艾滋病预防沿途的障碍 现在包括暴露前预防(PrEP)的级联。再加上强有力的培训和指导， 拟议的项目通过开展两项形成性研究直接满足这一需求。第一，信息 关于MSM对PrEP交付计划的各种属性的偏好，包括使用ATS的细分 男男性接触者，将被评估。然后，在第一项研究的基础上，候选人将开发和测试基于mHealth的 采取干预措施，克服预防过程中的障碍，包括艾滋病毒检测、共同发生的性行为 以及马来西亚男男性接触者的毒品危险行为和PrEP摄取率。这些相关项目的结果将 为应聘者提供必要的技能和能力，以开发和测试创新和量身定制的 对男男性行为者进行艾滋病初级预防干预。Shrestha博士的这份K01申请表非常适合 应聘者的职业生涯凭借他在干预设计、实施和安置方面的培训，他的最高 公共卫生研究的生产力，以及他在马来西亚背景下研究的不断发展的经验。完毕 5年内，他将获得新的技能和经验，以实现他的职业目标和目标：1)获得 具备决策科学经验，具备先进的定量和定性技能，成为独立的 艾滋病毒、药物使用和弱势人群移动健康干预方面的调查员；2)开发专业知识 在移动健康干预的开发、测试、实施和传播中，将解决特定的 在男男性接触者中提供艾滋病毒预防服务的障碍，特别是那些有药物使用障碍的人；以及3)发展 独立的职业道路，专注于使用移动健康战略在MSM中预防艾滋病毒。为了实现这些目标， 他组建了一支由艾滋病毒、药物使用、干预等方面的专业知识组成的优秀跨学科导师团队 设计、决策科学、高级生物统计学和移动健康研究。在他们的指导下，他将完成 相关教学工作，并参加研讨会和进行研究，以应用成为 MSM中基于移动健康的艾滋病毒预防的独立研究员。

Abstract Malaysia's HIV epidemic is rapidly expanding with recent evidence suggesting accelerated sexual transmission, especially among men who have sex with men (MSM): 10% in 2008 to 54% in 2016. Biobehavioral surveys suggest high HIV prevalence in MSM being nationally (21.6%) and in Kuala Lumpur (43%). This growing epidemic in MSM is associated with condomless sex (CS), STIs, and high usage of substance (particularly amphetamine-type stimulants; ATS). In Malaysia, both substance use and homosexuality are criminalized, making MSM dually bear the burden of social stigma and discrimination, including in healthcare. Consequently, they are marginalized from traditional, venue-based HIV prevention services, which undermines recommendations by international agencies. To address stigma and discrimination, mHealth (mobile technology to promote health) strategies can deliver prevention messages and guide health decisions anonymously, and thus hold great promise for MSM, especially those using ATS. They can overcome barriers along the HIV prevention cascade that now includes pre-exposure prophylaxis (PrEP). Combined with strong training and mentoring, the proposed projects directly address this need through the conduct of two formative studies. First, information about MSM's preferences of various attributes of PrEP delivery programs, including segmentation of ATS-using MSM, will be assessed. Then, building on the first study, the candidate will develop and test an mHealth-based intervention to overcome barriers along the prevention continuum, including HIV testing, co-occurring sexual and drug risk behaviors and PrEP uptake among Malaysian MSM. Findings from these related projects will provide the candidate with the necessary skills and competencies to develop and test an innovative and tailored primary HIV prevention intervention for MSM. This K01 application for Dr. Shrestha is well-suited to advance the career of the candidate by virtue of his training in intervention design, delivery, and placement, his high productivity in public health research, and his evolving experience with research in the Malaysian context. Over 5 years, he will achieve new skills and experiences to achieve his professional goals and objectives to: 1) gain experience in decision science with advanced quantitative and qualitative skills to become an independent investigator in HIV, substance use, and mHealth intervention for vulnerable populations; 2) develop expertise in mHealth intervention development, testing, implementation, and dissemination that will address specific barriers to HIV prevention services in MSM, especially those with substance use disorders; and 3) develop an independent career path focusing on HIV prevention in MSM using mHealth strategies. To achieve these goals, he has assembled a stellar interdisciplinary team of mentors with expertise in HIV, substance use, intervention design, decision science, advanced biostatistics, and mHealth research. Under their guidance, he will complete relevant didactic work and attend seminars and conduct research to apply the skills needed to become an independent researcher in mHealth-based HIV prevention among MSM.