The AIDS epidemic is a multitude of diverse epidemics. The epidemic throughout much of the Americas is concentrated primarily in men who have sex with men (MSM). Unlike all other risk groups in the US, HIV infection rates among MSM in the US have been climbing since the early 1990s. Epidemiologic research throughout much of Central and South America confirm these trends in MSM throughout these regions. Despite recent setbacks in the HIV vaccine and microbicide fields, a number of promising biomedical and behavioral HIV prevention strategies are currently under evaluation, with results expected in the next few years. These include pre-exposure prophylaxis (PrEP) (the use of antiretroviral medication for high-risk HIV uninfected person);male circumcision (highly effective for heterosexuals, not yet evaluated for MSM);treatment of stimulant use (many new promising pharmacologic agents being tested for methamphetamine and cocaine use);strategies to increase uptake and frequency of HIV testing (as people unaware of their infection appear to be driving the epidemic);prevention for HIV positive sex partners, including antiretroviral therapy (ART) and possible herpes (HSV2) suppressive therapy (for those who are HIV/HSV2 co-infected), and a variety of behavioral approaches, including interventions to improve adherence to medical regimens, minimize risk compensation, and help individuals with HIV disclosure and make sound decisions about serosorting. This application brings together a team of leading epidemiologists, biostatisticians, mathematical modelers, behavioral scientists, clinical scientists, and community members to build a comprehensive Prevention Umbrella for MSM in the Americas (the PUMA Project).
The specific aims are to 1) conduct systematic reviews, conduct epidemiologic analysis and modeling to guide the selection of individual and partnership-level HIV prevention interventions and the appropriate target populations for MSM in the Americas;2) build the individual components of a menu-driven HIV prevention package and design an individual-level randomized controlled trial to rigorously evaluate its impact on HIV seroincidence in high-risk HIV-uninfected MSM;and 3) determine the feasibility and acceptability of the individual and combined components of the proposed package of prevention package. The long term goal of this research is to develop an optimal HIV prevention package for MSM in the Americas and to design a clinical study to evaluate the safety and efficacy of this promising combination of interventions. This research will build a package of different medical and counseling approaches that, in combination, are likely to have the biggest impact on stopping new HIV infections in men who have sex with men in North and South America. At the end of this 4-year project, we will have a full package of prevention approaches that will be ready to be tested in 4000-5000 men in North and South America, to see if we can drive down infection rates in this population.

Public Health Relevance

This research will build a package of different medical and counseling approaches that, in combination, are likely to have the biggest impact on stopping new HIV infections in men who have sex with men in North and South America. At the end of this 4-year project, we will have a full package of prevention approaches that will be ready to be tested in 4000-5000 men in North and South America, to see if we can drive down infection rates in this population.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
5R01AI083060-02
Application #
7799365
Study Section
Special Emphasis Panel (ZAI1-GPJ-A (J1))
Program Officer
Chow, Grace C
Project Start
2009-04-10
Project End
2013-03-31
Budget Start
2010-04-01
Budget End
2011-03-31
Support Year
2
Fiscal Year
2010
Total Cost
$983,589
Indirect Cost
Name
Public Health Foundation Enterprises
Department
Type
DUNS #
082199324
City
City of Industry
State
CA
Country
United States
Zip Code
91746
Goodreau, Steven M; Rosenberg, Eli S; Jenness, Samuel M et al. (2017) Sources of racial disparities in HIV prevalence in men who have sex with men in Atlanta, GA, USA: a modelling study. Lancet HIV 4:e311-e320
Volk, Jonathan E; Lippman, Sheri A; Grinsztejn, Beatriz et al. (2016) Acceptability and feasibility of HIV self-testing among men who have sex with men in Peru and Brazil. Int J STD AIDS 27:531-6
Lippman, Sheri A; Koester, Kimberly A; Amico, K Rivet et al. (2015) Client and provider perspectives on new HIV prevention tools for MSM in the Americas. PLoS One 10:e0121044
Khanna, Aditya; Goodreau, Steven M; Wohlfeiler, Dan et al. (2015) Individualized diagnosis interventions can add significant effectiveness in reducing human immunodeficiency virus incidence among men who have sex with men: insights from Southern California. Ann Epidemiol 25:1-6
Khanna, Aditya S; Roberts, Sarah T; Cassels, Susan et al. (2015) Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis. PLoS One 10:e0134271
Carnegie, Nicole B; Goodreau, Steven M; Liu, Albert et al. (2015) Targeting pre-exposure prophylaxis among men who have sex with men in the United States and Peru: partnership types, contact rates, and sexual role. J Acquir Immune Defic Syndr 69:119-25
Carnegie, Nicole Bohme; Krivitsky, Pavel N; Hunter, David R et al. (2015) An approximation method for improving dynamic network model fitting. J Comput Graph Stat 24:502-519
Goodreau, Steven M; Carnegie, Nicole B; Vittinghoff, Eric et al. (2014) Can male circumcision have an impact on the HIV epidemic in men who have sex with men? PLoS One 9:e102960
Scott, Hyman M; Vittinghoff, Eric; Irvin, Risha et al. (2014) Age, race/ethnicity, and behavioral risk factors associated with per contact risk of HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr 65:115-21
Khanna, Aditya S; Goodreau, Steven M; Gorbach, Pamina M et al. (2014) Modeling the impact of post-diagnosis behavior change on HIV prevalence in Southern California men who have sex with men (MSM). AIDS Behav 18:1523-31

Showing the most recent 10 out of 22 publications