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

项目摘要/摘要 Rusley博士正在追求K23指导的以患者为导向的研究职业发展奖，以促进他的 过渡到一名独立的艾滋病毒预防科学家。他的职业目标是消除 面临艾滋病毒风险的青少年和青壮年。他有儿科和青少年医学、临床方面的背景。 研究、公共卫生和动机访谈(MI)，为拟议的培训和 研究计划。他组建了一支非常有成就和多样化的导师团队，在以下方面具有互补的专业知识 青春期性少数男性(ASMM)健康，艾滋病毒预防，包括暴露前预防(PrEP)，行为 青少年性行为研究中的干预措施、基于家庭的干预措施、实施科学和伦理问题。 这些导师，以及布朗大学出色的、高度跨学科的研究环境 罗德岛医院将促进他的培训和研究计划，以及他向独立的NIH- 受资助的研究员。鉴于美国性少数族裔男性承担的艾滋病毒负担不成比例--尤其是 年轻男性-事实上，这些男性中的大多数在青少年时期就有了第一次性行为，ASMM是一个关键 针对艾滋病病毒预防干预的人口。然而，基于证据的艾滋病毒预防干预措施很少。 对于这一群体，部分原因是父母参与研究的复杂性。许多专家呼吁将其纳入 父母在ASMM的艾滋病毒预防干预中的作用，因为他们可以在孩子的 然而，美国没有针对ASMM的以家庭为基础的艾滋病毒预防干预措施。PREP是一种高效的艾滋病毒 最近经FDA批准添加到现有艾滋病毒预防工具包中的预防工具，适用于 2018年，然而，ASMM的吸纳量一直很低。解决ASMM中PrEP摄取方面的这一差距的少数研究 建议可能的障碍可能包括：担心向父母披露性行为(“郊游”)、了解和 使用PrEP的动机，以及无法接触到开PrEP处方的初级保健临床医生。因此，我们将开发一种 针对ASMM的基于家庭的艾滋病毒预防干预，可用于初级保健环境。首先，我们将进行一项 形成性评估使用与ASMM(n=12-15)和父母(n=12-15)的深入个别访谈来确定 计划干预成功的障碍和促进者(具体目标(SA)1)。第二，我们将调整一种 现有的基于证据的动机访谈(MI)干预措施也包括PrEP教育和咨询 作为基于家庭的组成部分(基于视频的关于父母支持、性行为交流和 作为艾滋病毒预防的准备)。然后，我们将用ASMM-双亲联体(n=10)(SA2)进行干预试验。最后，我们会 进行ASMM双亲干预的探索性随机试验(n=100)，以测试其对PrEP的影响 在基线和8周随访时摄取，并确定可行性和可接受性(SA3)。总体而言，干预措施 将接触到难以接触的人群，建立保护性的父母关系，并增加关键人群中的PrEP接受率 从而减少新的艾滋病毒感染。拟议的培训和研究计划将为罗斯利博士提供 需要的经验和指导，以扩展他的技能，成为独立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.