HIV Prevention Research and Infrastructure Development in Syria and Middle East

描述(由申请人提供)：为响应PAR-08-153(“中东艾滋病毒/艾滋病合作研究”)，威斯康星州艾滋病干预研究中心(CAIR)//威斯康星州医学院--与社区卫生中心(CCH)/孟菲斯大学和叙利亚烟草研究中心(SCTS)合作--申请2年的资金，以收集叙利亚多个高危群体中艾滋病毒风险行为的第一阶段形成数据，这些人群包括艾滋病毒携带者、寻求性传播感染相关服务的人、商业性工作者、男男性行为者和注射吸毒者。数据将被用于为叙利亚高危人群制定与文化相关的艾滋病毒/性传播感染风险减少干预措施，可在随后的研究中进行评估。我们还将使用有声思考的方法来完善A-CASI风险行为调查，这将是在未来的研究中评估干预效果所必需的。为此，并响应PAR-08-153，我们提议的研究有三个主要目标。(1)确定艾滋病毒/性传播感染的风险和预防行为，在针对艾滋病毒/性传播感染和传播的高危人群，包括艾滋病毒携带者、求助性传播相关服务的人、女性商业性工作者、男男性行为者和注射吸毒者的后续预防干预中需要解决的媒介和调节者。(2)记录将这些艾滋病毒/性传播感染高危人群纳入预防干预研究的战略的可行性。(3)调整和完善量化危险行为调查的措辞和内容，该调查可用于评估未来的HIV/STI预防干预试验，该试验基于从这项形成性研究中吸取的经验教训。我们的研究设计和评估措施将在与社区咨询委员会密切协商的情况下制定，该委员会由叙利亚有影响力的宗教学者和关键的卫生服务和公共卫生利益攸关方组成。当地宗教学者和医疗保健提供系统的支持将增强我们成功实施基于证据的公共卫生艾滋病毒/性传播感染风险降低干预方案的能力。此外，CAIR和CCH的研究人员将与叙利亚SCTS的研究人员密切合作，发展当地的艾滋病毒研究基础设施、能力和专业知识。CAIR的研究人员在非美国国家建设当地研究能力方面有着悠久的历史。同样，CCH和SCTS的研究人员在叙利亚开发了非常成功的健康行为和流行病学研究基础设施，培训了许多当地科学家，并赢得了几个国际奖项。叙利亚项目协调员是叙利亚卫生部艾滋病毒预防服务的前主任。集体研究团队的各自优势为在疾病快速爆发之前在低流行率国家成功制定和实施具有文化能力的艾滋病毒/性传播感染预防干预计划奠定了坚实的基础。需要这种先发制人的努力，以遏制艾滋病毒/性传播感染在全球范围内的持续扩张，特别是在中东的伊斯兰-阿拉伯国家。我们的研究结果将被传播，用于在叙利亚以及更广泛的中东地区制定减少艾滋病毒/性传播感染风险的干预措施，因为叙利亚与该地区其他阿拉伯-伊斯兰国家在社会文化上有许多相似之处。 公共卫生相关性：在低流行率国家制定和实施具有文化能力的艾滋病毒/性传播感染预防干预研究方案，可以先发制人地遏制艾滋病毒/性传播感染快速爆发的可能性。需要这种先发制人的努力，以遏制艾滋病毒/性传播感染在全球范围内的持续扩张，特别是在中东-北非地区的伊斯兰-阿拉伯国家。我们的研究结果将被传播，用于在叙利亚以及更广泛的中东和北非地区制定减少艾滋病毒/性传播感染风险干预措施。

DESCRIPTION (provided by applicant): In response to PAR-08-153 ("Collaborative HIV/AIDS Studies in the Middle East"), the Center for AIDS Intervention Research (CAIR)//Medical College of Wisconsin-- in collaboration with the Center for Community Health (CCH)/University of Memphis and the Syrian Center for Tobacco Studies (SCTS)-- requests 2 years of funding to collect phase 1 formative data about HIV risk behavior among multiple at-risk groups in Syria, including people living with HIV, people seeking STI-related services, commercial sex workers, men who have sex with men, and injection drug users. Data will be used to inform development of culturally-relevant HIV/STI risk reduction interventions for at-risk groups in Syria that can be evaluated in subsequent studies. We also will use think-aloud methods to refine an A-CASI risk behavior survey that will be necessary to evaluate intervention effectiveness in future studies. Toward this end, and in response to PAR-08-153, our proposed study has three primary aims. (1) To identify HIV/STI risk and preventive behaviors, mediators, and moderators that will need to be addressed in a subsequent prevention intervention aimed at groups at high-risk for HIV/STI infection and transmission, including people living with HIV, people seeking STI-related services, female commercial sex workers, men who have sex with men, and injection drug users. (2)To document the feasibility of strategies to access and enroll these groups at high-risk for HIV/STI transmission and infection into a prevention intervention study. (3) To tailor and refine the wording and content of a quantitative risk behavior survey that can be used to evaluate a future HIV/STI prevention intervention trial that based on the lessons learned from this formative study. Our research design and assessment measures will be developed in close consultation with a Community Advisory Board, comprised of influential Religious Scholars and key health delivery and public health stakeholders in Syria. The support of local Religious Scholars and health care delivery systems will enhance our capacity to successfully implement evidence-based public health HIV/STI risk reduction intervention programs. Further, researchers from CAIR and CCH will work closely with researchers at SCTS in Syria to develop local HIV research infrastructure, capacity, and expertise. CAIR researchers have a long history of building local research capacity in non-U.S. countries. Likewise, researchers at CCH and SCTS have developed a very successful health behavior and epidemiological research infrastructure in Syria which has trained many local scientists and won several international awards. The Syrian Project Coordinator is the former Director of HIV Prevention Services for the Syrian Health Ministry. The respective strengths of the collective research teams provide a strong foundation to successfully develop and implement a culturally- competent program of HIV/STI prevention intervention in a low prevalence country before a rapid disease outbreak occurs. Such preemptive efforts are needed to stem the continued global expansion of HIV/STIs, especially in Islamic-Arab countries of the Middle East. Findings from our study will be disseminated for use in the development of HIV/STI risk reduction interventions in Syria, as well as the broader Middle East region given the many sociocultural similarities between Syria and other Arab-Islamic countries in this region. PUBLIC HEALTH RELEVANCE: The development and conduct of a program of culturally-competent HIV/STI prevention intervention research in a low prevalence country can preemptively stem the potential of a rapid outbreak of HIV/STIs. Such preemptive efforts are needed to stem the continued global expansion of HIV/STIs, especially in Islamic- Arab countries of the Middle East-North Africa (MENA) region. Findings from our study will be disseminated for use in the development of HIV/STI risk reduction interventions in Syria, as well as the broader MENA region.