A family-based intervention to improve HIV pre-exposure prophylaxis uptake for adolescent sexual minority males

项目总结/摘要 博士Rusley正在追求这个K23指导的以患者为导向的研究职业发展奖，以促进他的 成为一名独立的艾滋病预防科学家。他的职业目标是消除健康差距， 有感染艾滋病毒风险的青少年和年轻人。他有儿科和青少年医学的背景， 研究，公共卫生和动机面试（MI），为拟议的培训奠定坚实的基础， 研究计划。他组建了一个非常有成就和多样化的导师团队，他们在以下方面具有互补的专业知识： 青少年性少数男性（ASMM）健康，艾滋病毒预防，包括暴露前预防（PrEP），行为 干预措施，以家庭为基础的干预措施，实施科学和青少年性研究的伦理问题。 这些导师，沿着在布朗大学优秀和高度跨学科的研究环境， 罗得岛医院将促进他的培训和研究计划，以及他过渡到一个独立的，国家卫生研究院- 资助的研究员。考虑到美国性少数男性所承担的艾滋病毒负担不成比例， 事实上，这些男性中的大多数人在青少年时期就有了第一次性经历，ASMM是一个关键因素。 艾滋病毒预防干预措施。然而，基于证据的艾滋病毒预防干预措施很少 对于这个群体来说，部分原因是父母参与研究的复杂性。许多专家呼吁， 父母在艾滋病毒预防干预ASMM，考虑到他们可以发挥关键的保护作用， 然而，在美国，ASMM没有以家庭为基础的艾滋病毒预防干预措施。PrEP是一种非常有效的艾滋病毒 预防工具，最近已被添加到现有的艾滋病毒预防工具包与FDA批准的青少年， 2018年，ASMM的吸收率一直很低。少数几项研究解决了ASMM中PrEP摄取的这一差距， 建议可能的障碍可能包括：对向父母透露性行为（“郊游”）的关切， 使用PrEP的动机，以及缺乏处方PrEP的初级保健临床医生。因此，我们将开发一种 针对ASMM的以家庭为基础的艾滋病毒预防干预，可用于初级保健环境。首先，我们会进行一项 形成性评价，采用与ASMM（n=12-15）和家长（n=12-15）的深入个人访谈，以确定 计划干预成功的障碍和促进因素（具体目标（SA）1）。第二，我们将调整 现有的以证据为基础的动机性访谈（MI）干预措施，包括PrEP教育和咨询，以及 作为一个以家庭为基础的组成部分（关于父母支持、性交流和 PrEP作为HIV预防）。然后，我们将用ASMM-父母二联体（n=10）（SA 2）进行干预试验。最后我们将 进行ASMM-父母二人干预的探索性随机试验（n=100），以测试其对PrEP的影响 基线和8周随访时的摄取，并确定可行性和可接受性（SA 3）。总的来说，干预 将接触到难以接触的人群，建立保护性的父母关系，并在关键人群中增加PrEP的摄入。 减少高危人群，从而减少新的艾滋病毒感染。拟议中的培训和研究计划将为鲁斯利博士提供 经验和指导需要扩大他的技能，并成为一个独立的和领先的艾滋病毒预防 科学家

PROJECT SUMMARY/ABSTRACT Dr. Rusley is pursuing this K23 Mentored Patient-Oriented Research Career Development Award to facilitate his transition to an independent HIV prevention scientist. His career goal is to eliminate health disparities among adolescents and young adults at risk for HIV. He has a background in pediatric and adolescent medicine, clinical research, public health, and motivational interviewing (MI) that create a strong foundation for the proposed training and research plan. He has assembled a highly accomplished and diverse team of mentors with complementary expertise in adolescent sexual minority male (ASMM) health, HIV prevention including pre-exposure prophylaxis (PrEP), behavioral interventions, family-based interventions, implementation science, and ethical issues in adolescent sexuality research. These mentors, along with an excellent and highly-interdisciplinary research environment at Brown University and Rhode Island Hospital will facilitate his training and research plan, as well as his transition to an independent, NIH- funded researcher. Given the disproportionate burden of HIV borne by sexual minority males in the US—especially young men—and the fact that most of these men have their first sexual experience as adolescents, ASMM are a key population for HIV prevention interventions. However, there are very few evidence-based HIV prevention interventions for this group, in part due to complexities with parental involvement in research. Many experts have called for inclusion of parents in HIV prevention interventions for ASMM, given the key protective roles they can play in their children’s lives; yet there are no family-based HIV prevention interventions for ASMM in the US. PrEP is a highly effective HIV prevention tool that has recently been added to the existing HIV prevention toolkit with FDA approval for adolescents in 2018, yet uptake among ASMM has been low. The few studies that address this gap in PrEP uptake among ASMM suggest possible barriers may include: concerns about disclosure of sexuality to parents (“outing”), knowledge of and motivation to use PrEP, and lack of access to primary care clinicians who prescribe PrEP. Therefore, we will develop a family-based HIV prevention intervention for ASMM that can be used in primary care settings. First, we will conduct a formative evaluation using in-depth individual interviews with ASMM (n=12-15) and parents (n=12-15) to determine barriers and facilitators to the success of the planned intervention (Specific Aim (SA) 1). Second, we will adapt an existing evidenced-based, motivational interviewing (MI) intervention to include PrEP education and counseling, as well as a family-based component (a video-based education module about parental support, sexuality communication, and PrEP as HIV prevention). We will then pilot the intervention with ASMM-parent dyads (n=10) (SA2). Finally, we will conduct an exploratory randomized trial of the intervention with ASMM-parent dyads (n=100) to test its effect on PrEP uptake at baseline and 8-week follow up, and to determine feasibility and acceptability (SA3). Overall, the intervention will reach a difficult to access population, build protective parent relationships, and increase PrEP uptake among a key population at risk, thereby reducing new HIV infections. The proposed training and research plan will provide Dr. Rusley the experience and mentoring needed to expand his skills and become an independent and leading HIV prevention scientist.