The Impact of Alcohol on PrEP Adherence in Vulnerable Men

项目总结和摘要 酒精是同性恋和双性恋男性（GBM）最常用的物质。此外，酒精是 与GBM文化有着千丝万缕的联系，经常被用作性活动的先驱或推动者。涉酒 性行为通常涉及从事性行为，使人处于艾滋病毒血清转化的高风险中， 无套肛交暴露前预防（PrEP）可有效预防HIV血清转化，但 推荐的药物配方是每天服用的药丸， 有效与不使用GBM相比，使用GBM的物质的依从性水平较低 GBM，但很少有研究调查酒精消费对PrEP依从性的影响。 因此，拟议的研究将收集试点数据，以调查酒精使用和滥用对 PrEP依从性。在这个指导职业发展奖（K 01），威斯特摩兰博士将描述模式 使用PrEP的GBM中的酒精使用和性行为，确定酒精使用在日常生活中的作用 使用多种方法收集聚合物（例如，30天）和详细（例如生态 瞬时评估（EMA））数据，并将与饮酒相关的PrEP不依从性置于情境中。 在目标1中，Westmoreland博士将使用基线定性和定量数据来描述酒精模式 使用和性行为。她还将使用定性访谈的叙述来增加不断增长的 文献周围的障碍PrEP吸收和参与PrEP护理连续。在目标2中，博士 Westmoreland将使用多种数据来源-即定量调查、时间轴跟踪访谈 （TLFB）、每周两次收集的日志记录（即EMA数据）和干血斑（DBS），持续10周 用于酒精和PrEP依从性监测的样本-定量确定酒精在 每天坚持PrEP。通过使用多种数据收集技术，她还将能够查明和 验证酒精使用和PrEP依从性的估计值。在目标3中，Westmoreland博士将使用定性数据 从后续采访到情境化与饮酒相关的PrEP不依从性。此外，本发明还 她将使用这些后续访谈来帮助描述参与者在风险方面的感知变化， 可能导致偏离每日PrEP使用的随访时间段。威斯特摩兰医生会根据她的前科 培训作为性病和艾滋病毒流行病学家，以扩大她的专业知识到酒精研究和开发新的 进行有影响力的性行为研究所需的分析技能。这些技能将包括收集和 分析定性数据;使用EMA，TLFB和DBS数据;实施科学，赠款写作， 科学沟通。通过方法课程和讲习班，酒精为重点的讲习班， 研讨会，导师，和专业会议，威斯特摩兰博士将获得她需要申请的技能 她获得了第一笔R 01赠款，并作为终身首席研究员从事艾滋病毒预防研究。

PROJECT SUMMARY AND ABSTRACT Alcohol is the most prevalently used substance among gay and bisexual men (GBM). Additionally, alcohol is inextricably linked to GBM culture and often used as a precursor or enabler of sexual activity. Alcohol-involved sex often involves engaging in sexual behavior that places persons at higher risk for HIV seroconversion such as condomless anal sex. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV-seroconversion, but recommended medication formulations are daily pills with moderately high levels of adherence to be most effective. Substance-using GBM have been shown to have lower levels of adherence compared to non-using GBM, but scant research has investigated the impact that alcohol consumption has on PrEP adherence. Therefore, the proposed study will collect pilot data to investigate the effects of alcohol use and misuse on PrEP adherence. In this mentored career development award (K01), Dr. Westmoreland will describe patterns of alcohol use and sexual behavior among PrEP-using GBM, identify the role that alcohol use plays in daily PrEP adherence using multiple methodologies to collect aggregate (e.g., 30 day) and detailed (e.g. ecological momentary assessment (EMA)) data, and contextualize PrEP non-adherence related to alcohol consumption. In Aim 1, Dr. Westmoreland will use baseline qualitative and quantitative data to describe patterns of alcohol use and sexual behavior. She will also use the narratives from qualitative interviews to add to the growing literature surrounding barriers to PrEP uptake and engagement in the PrEP care continuum. In Aim 2, Dr. Westmoreland will use multiple sources of data—i.e. quantitative surveys, timeline follow-back interviews (TLFB), diary entries collected twice-weekly for 10 weeks (i.e. EMA data), and dried blood spot (DBS) specimens for alcohol and PrEP adherence monitoring—to quantitatively identify the role that alcohol plays in daily PrEP adherence. By using multiple data collection techniques, she will also be able to pinpoint and validate estimates of alcohol use and PrEP adherence. In Aim 3, Dr. Westmoreland will use qualitative data from follow-up interviews to contextualize PrEP non-adherence related to alcohol consumption. Additionally, she will use these follow-up interviews to help characterize participants’ perceived changes in risk over the follow-up time period that could lead to deviations from daily PrEP use. Dr. Westmoreland will build on her prior training as a STI and HIV epidemiologist to expand her expertise into alcohol research and develop new analytical skills needed to conduct impactful sexual behavior research. These skills will include collecting and analyzing qualitative data; working with EMA, TLFB, and DBS data; implementation science, grant-writing, and scientific communication. Through methods coursework and workshops, alcohol-focused workshops and seminars, mentorship, and professional meetings, Dr. Westmoreland will gain the skills she needs to apply for her first R01 grant and pursue a career in HIV prevention research as a tenure-track principal investigator.