Enhancing HIV prevention and reducing alcohol use among people receiving STI care in Malawi: An HIV status neutral approach

项目摘要 艾滋病毒仍然是包括马拉维在内的整个撒哈拉以南非洲的一个重大公共卫生问题。 性传播感染（STI）护理环境是同时接触病毒的未充分利用的场所。 未受抑制的艾滋病毒感染者（PWH）和艾滋病毒高危人群，并有可能优化艾滋病毒 预防和治疗结果。危险的酒精使用在马拉维和 艾滋病毒/艾滋病是艾滋病毒预防工作取得成功的一个关键障碍。TrEAT是一个简短的，高度 有效的，文化上适当的，可扩展的，以证据为基础的干预措施（EBI）减少酒精。而 TrEAT在文化上适合于不同的环境，但尚未适应不断变化的艾滋病毒护理环境 包括威尔斯亲王医院及爱滋病高危人士。通过前期工作，我们的团队已经证明， （1）在撒南非洲（包括马拉维）接受性传播感染治疗的人群中，危险酒精使用非常普遍; 2)TrEAT在文化上是适当的，可行的，可接受的，有效地减少酒精使用和改善 全球范围内PWH的病毒抑制，包括SSA;以及3）成功地导致酒精 艾滋病毒预防和治疗的有效性和执行情况的研究。总体目标是 R34应用是为了产生一种文化适应性强、可扩展的艾滋病毒“中性状态”EBI，用于减少酒精摄入， HIV预防和治疗优化在R 01混合有效性实施试验中进行测试。我们将 进行一项比较TrEAT 4All与常规治疗的2组初步随机对照试验（RCT），以评估 在一个性传播感染护理环境中开展艾滋病毒预防和治疗的初步效果和实施工作， 作为马拉维利隆圭的早期暴露前预防（PrEP）实施点。借鉴 我们以前的手动干预措施，我们将开发一个3节干预，TrEAT 4All，整合艾滋病毒 将预防和治疗咨询纳入TrEAT，以改善艾滋病毒预防结果-为那些 有感染爱滋病病毒和病毒抑制的危险。我们的具体目标是：1）调整TrEAT，一个EBI， 减少饮酒，为威尔斯亲王医院和高危人士提供艾滋病病毒中性身份辅导（TrEAT 4All） 在马拉维报告大量饮酒并接受性传播感染治疗的人; 2）评估短期疗效， 实施TrEAT 4All以优化艾滋病毒预防和治疗结果（ 威尔斯亲王医院;爱滋病病毒高危人士使用预防前预防措施的情况）及过去30天内大量饮酒日数的比例;及3） 探索干预参与者中TrEAT 4All反应性的途径。结果将具有相关性 将减少酒精的EBI纳入现实世界的STI护理环境，以优化艾滋病毒预防， 在撒哈拉以南非洲和其他酒精在艾滋病毒中起作用的地区， 传播.

PROJECT SUMMARY HIV continues to be a significant public health problem throughout sub-Saharan Africa, including in Malawi. Sexually transmitted infection (STI) care settings are underutilized venues to simultaneously reach virally unsuppressed people with HIV (PWH) and those at high risk of HIV and have the potential to optimize HIV prevention and treatment outcomes. Hazardous alcohol use is widespread in Malawi and among people receiving STI care and is a critical barrier to the success of HIV prevention efforts. TrEAT is a brief, highly effective, culturally appropriate, scalable, evidence-based intervention (EBI) for alcohol reduction. While culturally appropriate for diverse settings, TrEAT has not been adapted for the shifting HIV care environment that includes both PWH and people at high risk for HIV. Through preliminary work, our team has demonstrated that: 1) Hazardous alcohol use is highly prevalent among people receiving STI care in SSA, including Malawi; 2) TrEAT is culturally appropriate, feasibile, acceptable, and effective at reducing alcohol use and improving viral suppression among PWH across global settings, including in SSA; and 3) Successfully led alcohol reduction and HIV prevention and treatment effectiveness and implementation studies. The overall goal for this R34 application is to produce a culturally adapted, scalable HIV ‘status-neutral’ EBI for alcohol reduction and HIV prevention and treatment optimization to test in an R01 hybrid effectiveness-implementation trial. We will conduct a 2-arm pilot randomized controlled trial (RCT) comparing TrEAT4All to usual care to assess the preliminary efficacy and implementation of HIV prevention and treatment within one STI care setting which serves as an early Pre-exposure Prophylaxis (PrEP) implementation site in Lilongwe, Malawi. Drawing from our previous manualized interventions, we will develop a 3-session intervention, TrEAT4All, that integrates HIV prevention and treatment counseling into TrEAT to improve HIV prevention outcomes—PrEP use for those who are at risk for HIV and viral suppression for PWH. Our specific aims are to 1) Adapt TrEAT, an EBI for alcohol reduction, to integrate HIV status-neutral counseling (TrEAT4All) for PWH and those at high risk of HIV who report heavy drinking and are receiving STI care in Malawi; 2) Evaluate short-term efficacy and implementation of TrEAT4All for optimizing HIV prevention and treatment outcomes (viral suppression among PWH; PrEP use among those at high risk of HIV) and proportion of heavy drinking days in past 30 days; and 3) Explore pathways of TrEAT4All responsiveness among intervention participants. Results will have relevance for integrating alcohol reduction EBIs into real-world STI care settings to optimize HIV prevention and treatment programs throughout sub-Saharan Africa and other regions where alcohol plays a role in HIV spread.