Using behavioral economics to improve the uptake of and persistence on pre-exposure prophylaxis in men who have sex with men to prevent HIV infection

项目摘要/摘要 这是为劳伦斯·朗博士申请为期五年的K01奖项的申请，劳伦斯·朗博士是哈佛大学的研究助理教授 波士顿大学。K01奖将支持一系列相辅相成的培训活动和研究目标 旨在将龙博士确立为艾滋病毒预防和行为领域的独立研究员 经济学。这将使龙博士能够实现他的长期职业目标，即领导艾滋病毒研究，指导 设计健康提供方案(治疗和预防)，鼓励最佳健康行为和 做决定。K01将提供必要的支持，以实现以下培训目标：1) 获得在男男性接触者中使用暴露前预防(PrEP)的专业技术知识 人；2)学习、掌握和应用人类决策理论；3)熟练设计 和实施行为改变干预措施，以及4)成功申请独立研究 资金问题。为了实现这些培训目标，龙博士提出了一项以 围绕着强大的导师支持，在行为经济学的说教培训，定性研究 与弱势群体合作的方法和研究方法。尽管进行了最大规模的艾滋病毒治疗 南非的艾滋病毒发病率仍然很高，特别是在关键人群中，如 与男性发生性关系的男性(MSM)。最近将艾滋病毒暴露前预防(PrEP)纳入为 南非的国家预防方案被认为是减少这些人口发病率的关键， 然而，试点研究显示，在风险最高的人群中，吸毒率不是最理想的，持久性较差。龙医生的 研究将侧重于了解为什么南非男男性接触者的PrEP摄取率和持久性较低 以及如何改变向这些人群提供PrEP的方式，以鼓励那些风险最高的人开始 治疗。这项研究的目的是：1)确定南方地区PrEP启动和持续的预测因子 非洲男男性接触者在PREP试点的检测呈阴性；2)定性地检查认知偏见在 从医疗保健提供者和患者的角度决定要求、提供、接受和继续接受PrEP； 3)制定和试点一项简单的干预措施，以增加使用PrEP的男男性行为者对PrEP的吸收和持久性 改善决策的行为经济学理论。为了实现这些目标，龙博士 访问目前在南非向男男性接触者提供PrEP的两个试点网站。在K01落成前 奖励Long博士将利用这项研究作为R01拨款申请的基础，该申请的目标是进行 确定行为经济干预改善PrEP的有效性的随机对照试验 在不同关键人群中的吸毒率。

PROJECT SUMMARY / ABSTRACT This is an application for a five-year K01 award for Dr. Lawrence Long, a Research Assistant Professor at Boston University. The K01 award will support a complementary set of training activities and research aims aimed at establishing Dr. Long as an independent researcher in the field of HIV prevention and behavioral economics. This will allow Dr. Long to reach his long-term career goal of leading HIV research that guides the design of health delivery programs (treatment and prevention) which encourages optimal health behavior and decision making. The K01 will provide the support necessary to accomplish the following training goals: 1) to obtain expert technical knowledge in the use of pre-exposure prophylaxis (PrEP) in men who have sex with men; 2) to learn, master and apply the theory of human decision making; 3) to become skilled in the design and implementation of behavior change interventions and 4) to successfully apply for independent research funding. In order to achieve these training goals Dr. Long has proposed a career development plan centered around strong mentorship supported by didactic training in behavioral economics, qualitative research methods, and research approaches for working with vulnerable populations. Despite the largest HIV treatment program in the world South Africa’s HIV incidence remains high, in particular amongst key populations such as men who have sex with men (MSM). The recent inclusion of HIV pre-exposure prophylaxis (PrEP) as part of the national prevention package in South Africa is considered key to reducing incidence in these populations, yet pilot studies show sub optimal uptake and poor persistence amongst those most at risk. Dr. Long’s research will focus on understanding why PrEP uptake and persistence amongst MSM in South Africa is low and how the delivery of PrEP to this population could be altered to encourage those most at risk to start treatment. The research will aim to: 1) identify predictors of PrEP initiation and persistence amongst South African MSM testing negative at PREP pilot sites; 2) qualitatively examine the role of cognitive bias in the decision to request, offer, accept and continue on PrEP from a health care provider and patient perspective; and 3) develop and pilot a simple intervention to increase the uptake of and persistence on PrEP in MSM using behavioral economic theory to improve decision making. In order to accomplish these aims Dr. Long has access to the two pilot sites currently offering PrEP to MSM in South Africa. Before the completion of the K01 award Dr. Long will use this research as the basis for an R01 grant application which would aim to conduct a randomized control trial to establish the effectiveness of behavioral economic interventions in improving PrEP uptake amongst various key populations.