Comprehensive HIV Prevention Package for MSM in Southern Africa

描述（由申请人提供）：本申请的总体目标是为南部非洲的男男性行为者（MSM）开发一套优化的艾滋病毒预防服务组合，开发关于候选方案可接受性的初步数据，并为预防方案的后续有效性试验制定合理的建议。这项研究的基本原理很简单：几乎没有工作，无论是在研究或规划领域，都集中在艾滋病毒预防干预措施的男男性接触者在南部非洲地区，尽管新出现的证据表明，一个严重的艾滋病毒流行病正在这些男人。南部非洲开始出现男男性行为者社区，他们是在世界上最先进和最普遍的艾滋病毒流行病的背景下这样做的。非洲男男性行为者仍然是艾滋病毒流行中最隐蔽和最受侮辱的高危群体之一，对他们来说，适合当地挑战性环境的优化预防方案是一个紧迫的公共卫生和研究优先事项。我们的小组在马拉维、纳米比亚、博茨瓦纳、莱索托进行了第一次MSM流行病学研究，并在开普敦城郊的非洲和有色MSM社区进行了第一次此类研究。这些研究为如何在这些具有挑战性的环境中安全地进行艾滋病毒研究提供了专业知识，并证明了与男男性行为者和LGBT社区组织合作在成功进行这一迫切需要的研究方面的首要地位。我们将利用这一专业知识，通过四项具体举措制定我们最优化的艾滋病毒预防方案：对南部非洲男男性行为者的行为、生物医学和结构干预文献进行全面审查;建立一个数学模型，解释与男性的性行为，与女性的性行为，包皮环切情况，插入率，抗逆转录病毒药物的使用，和风险环境，以评估实施行为、生物医学和社区一级的一揽子干预措施对艾滋病毒传播的影响;在赞比亚的卢萨卡和南非开普敦周围的两个主要是非洲人（黑人）的城镇对预防一揽子计划的可接受性和可行性进行试点研究;并利用试点研究的初步信息，设计一个更大的，确定性的研究，预防包的功效 公共卫生相关性：在非洲，男男性行为者在很大程度上是一个隐藏的人群，面临着感染艾滋病毒的巨大风险。本研究建议使用现有的知识和文献和数学建模的审查过程中，制定一套艾滋病预防干预措施的男男性接触者在非洲，并试点测试的可接受性，在卢萨卡，赞比亚和开普敦，南非。

DESCRIPTION (provided by applicant): The overarching aim of this application is to develop an optimized combination package of HIV prevention services for men who have sex with men (MSM) in southern Africa, to develop preliminary data about the acceptability of the candidate package, and to develop a rational proposal for a subsequent efficacy trial of the prevention package. The rationale for this study is simple: virtually no work, in either research or programmatic areas, has focused on HIV preventive interventions for MSM in the Southern African region-despite emerging evidence that a severe epidemic of HIV is underway among these men. Communities of MSM are beginning to emerge in Southern Africa and they are doing so in the context of the world's most advanced and generalized epidemic of HIV. African MSM remain among the most hidden and stigmatized groups at risk in the HIV epidemic, and one for whom optimized prevention packages, fit to challenging local environments, are an urgent public health and research priority. Our group has conducted the first epidemiologic studies of MSM in Malawi, Namibia, Botswana, Lesotho and the first such studies among African and Colored MSM communities in peri-urban Cape Town. These studies have yielded expertise in how to safely conduct HIV research in these challenging environments, and have demonstrated the primacy of partnership with MSM and LGBT community organizations in the successful conduct of this critically needed research. We will use this expertise to develop our optimized HIV prevention package through four specific initiatives: conducting an umbrella review of literature on behavioral, biomedical, and structural interventions for MSM in Southern Africa; developing a mathematical model that accounts for sex with men, sex with women, circumcision status, insertivity ratios, ARV use, and the risk environment to estimate the impact on HIV transmission of implementation of a package of behavioral, biomedical, and community-level interventions; conducting pilot studies of acceptability and feasibility of the prevention package in Lusaka, Zambia and 2 predominately (black) African townships surrounding Cape Town, South Africa; and using preliminary information from the pilot study to design a larger, definitive study of the efficacy of the prevention package PUBLIC HEALTH RELEVANCE: Men who have sex with men in Africa are a largely hidden population at tremendous risk of HIV infection. This study proposes to use a process of review of existing knowledge and literature and mathematical modeling to develop a package of HIV prevention interventions for MSM in Africa, and to pilot test the acceptability of the package in Lusaka, Zambia and Cape Town, South Africa.