Prevention Umbrella for MSM in the Americas

描述（由申请人提供）： 艾滋病是一种多种多样的流行病。在美洲大部分地区，这一流行病主要集中在男男性行为者（MSM）身上。与美国所有其他风险群体不同，自20世纪90年代初以来，美国男男性行为者的艾滋病毒感染率一直在攀升。在中美洲和南美洲大部分地区的流行病学研究证实了这些地区MSM的这些趋势。尽管最近在艾滋病毒疫苗和杀微生物剂领域遇到挫折，但目前正在评估一些有希望的生物医学和行为艾滋病毒预防战略，预计在今后几年内会有结果。这些措施包括暴露前预防（PrEP）（对未感染艾滋病毒的高危人群使用抗逆转录病毒药物）;男性包皮环切术（对异性恋者非常有效，尚未对MSM进行评估）;治疗兴奋剂使用（许多新的有希望的药物制剂正在测试甲基苯丙胺和可卡因的使用）;提高艾滋病毒检测率和频率的战略（因为不知道自己感染的人似乎在推动流行病）;预防HIV阳性性伴侣，包括抗逆转录病毒治疗（ART）和可能的疱疹（HSV 2）抑制治疗（对于HIV/HSV 2合并感染者），以及各种行为方法，包括干预措施，以提高对药物治疗方案的依从性，最大限度地减少风险补偿，并帮助个人与艾滋病毒披露，并作出明智的决定，血清分选。该应用程序汇集了领先的流行病学家，生物统计学家，数学建模师，行为科学家，临床科学家和社区成员的团队，以建立一个全面的预防伞在美洲的男男性接触者（该项目）。具体目标是：1）进行系统性审查，进行流行病学分析和建模，以指导选择个人和伙伴一级的艾滋病毒预防干预措施以及美洲男男性行为的适当目标人群; 2）建立菜单驱动的艾滋病毒预防包的各个组成部分，并设计一项个人水平的随机对照试验，以严格评估其对高危艾滋病毒感染者中艾滋病毒血清发生率的影响-未感染的MSM;以及3）确定所建议的一揽子预防措施的单个和组合组成部分的可行性和可接受性。这项研究的长期目标是为美洲的男男性行为者开发一套最佳的艾滋病毒预防方案，并设计一项临床研究，以评估这种有希望的干预措施组合的安全性和有效性。这项研究将建立一套不同的医疗和咨询方法，这些方法结合起来，可能对阻止北美和南美男男性行为者感染新的艾滋病毒产生最大的影响。在这个为期4年的项目结束时，我们将有一整套预防方法，准备在北美和南美的4000-5000名男性中进行测试，看看我们是否可以降低这一人群的感染率。

DESCRIPTION (provided by applicant): The AIDS epidemic is a multitude of diverse epidemics. The epidemic throughout much of the Americas is concentrated primarily in men who have sex with men (MSM). Unlike all other risk groups in the US, HIV infection rates among MSM in the US have been climbing since the early 1990s. Epidemiologic research throughout much of Central and South America confirm these trends in MSM throughout these regions. Despite recent setbacks in the HIV vaccine and microbicide fields, a number of promising biomedical and behavioral HIV prevention strategies are currently under evaluation, with results expected in the next few years. These include pre-exposure prophylaxis (PrEP) (the use of antiretroviral medication for high-risk HIV uninfected person); male circumcision (highly effective for heterosexuals, not yet evaluated for MSM); treatment of stimulant use (many new promising pharmacologic agents being tested for methamphetamine and cocaine use); strategies to increase uptake and frequency of HIV testing (as people unaware of their infection appear to be driving the epidemic); prevention for HIV positive sex partners, including antiretroviral therapy (ART) and possible herpes (HSV2) suppressive therapy (for those who are HIV/HSV2 co-infected), and a variety of behavioral approaches, including interventions to improve adherence to medical regimens, minimize risk compensation, and help individuals with HIV disclosure and make sound decisions about serosorting. This application brings together a team of leading epidemiologists, biostatisticians, mathematical modelers, behavioral scientists, clinical scientists, and community members to build a comprehensive Prevention Umbrella for MSM in the Americas (the PUMA Project). The specific aims are to 1) conduct systematic reviews, conduct epidemiologic analysis and modeling to guide the selection of individual and partnership-level HIV prevention interventions and the appropriate target populations for MSM in the Americas; 2) build the individual components of a menu-driven HIV prevention package and design an individual-level randomized controlled trial to rigorously evaluate its impact on HIV seroincidence in high-risk HIV-uninfected MSM; and 3) determine the feasibility and acceptability of the individual and combined components of the proposed package of prevention package. The long term goal of this research is to develop an optimal HIV prevention package for MSM in the Americas and to design a clinical study to evaluate the safety and efficacy of this promising combination of interventions. This research will build a package of different medical and counseling approaches that, in combination, are likely to have the biggest impact on stopping new HIV infections in men who have sex with men in North and South America. At the end of this 4-year project, we will have a full package of prevention approaches that will be ready to be tested in 4000-5000 men in North and South America, to see if we can drive down infection rates in this population.