Prevention Umbrella for MSM in the Americas

描述(由申请人提供)： 艾滋病的流行是一种多种多样的流行病。美洲大部分地区的疫情主要集中在男男性行为者(MSM)中。与美国所有其他风险群体不同，美国男男性接触者的艾滋病毒感染率自20世纪90年代初以来一直在攀升。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男男性接触者的这些趋势。尽管艾滋病毒疫苗和杀微生物剂领域最近遭遇挫折，但一些有希望的生物医学和行为预防艾滋病毒战略目前正在评估中，预计将在未来几年内取得成果。这些措施包括暴露前预防(PrEP)(对高危艾滋病毒未感染者使用抗逆转录病毒药物)；男性包皮环切术(对异性恋非常有效，尚未对MSM进行评估)；兴奋剂治疗(许多新的有希望的药剂正在进行甲基苯丙胺和可卡因使用测试)；增加艾滋病毒检测的摄取率和频率的战略(因为不知道自己感染的人似乎正在推动疫情)；针对HIV阳性性伴的预防，包括抗逆转录病毒疗法(ART)和可能的疱疹(HSV2)抑制疗法(针对HIV/HSV2混合感染者)，以及各种行为方法，包括干预措施，以提高对医疗方案的依从性，将风险补偿降至最低，并帮助个人披露艾滋病毒并就血清检测做出正确决定。该应用程序汇集了一支由领先的流行病学家、生物统计学家、数学建模专家、行为科学家、临床科学家和社区成员组成的团队，以构建一个全面的美洲MSM预防伞(PUMA项目)。其具体目标是：1)进行系统的审查，进行流行病学分析和建模，以指导美洲男男性行为者选择个人和伙伴关系层面的艾滋病毒预防干预措施和适当的目标人群；2)建立菜单驱动的艾滋病毒预防一揽子计划的单独组成部分，并设计个人水平的随机对照试验，以严格评估其对未感染艾滋病毒的高危男男性行为者艾滋病毒血清发病率的影响；以及3)确定拟议一揽子预防计划的单独组成部分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MSM制定最佳艾滋病毒预防方案，并设计一项临床研究，以评估这一有希望的干预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，这些方法结合在一起，可能会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影响。在这个为期4年的项目结束时，我们将有一套完整的预防方法，准备在北美和南美洲的4000-5000名男性中进行测试，看看我们是否可以降低这些人口的感染率。

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.