Focus: HIV prevention and treatment among men who have sex with men (MSM)
Affiliation: Asociación Civil Impacta Salud y Educación; Yale Schools of Public Health and Medicine
Site and Background: The training site will include Impacta Peru, the country’s largest HIV/AIDS Service Organization and research institute that is a member of the AIDS Clinical Trials Group (ACTG), HIV Prevention Trials Network (HPTN) and the HIV Vaccine Trials Network (HVTN). They have ongoing relationships with many of the country’s largest NGOs that provide HIV and TB prevention and treatment in Peru, the Ministry of Health and Cayetano Herredia School of Medicine. Drs. Altice and Sanchez have collaborated together since 2010 in these sites, which have served as training sites for numerous pre- and post-doctoral fellows. The team has conducted bio-behavioral surveillance studies, health services research, interventions that promote HIV testing, linkage and retention in care and other health outcomes. Specifically, this team has been exploring the impact of alcohol use disorders and drug use among men who have sex with men (MSM) because Peru is experiencing a concentrated epidemic among this group. Some of the interventions being considered include mHealth interventions delivered using an app. New studies are examining the risk of TB treatment adherence and completion among those with and without alcohol and drug use disorders. Primary and secondary prevention studies are underway, including treatment as prevention and adherence studies using medication-assisted therapy (e.g., naltrexone) and behavioral interventions.
In addition, Impacta has relationships with many other universities including University of Washington and UCLA, where there are many active research projects. Drs. Altice and Sanchez collaborate on two active R01 grants from the NIDA and NIAAA and are writing new grants to expand some of this work to TB. The primary R01 is to expand HIV testing and to examine the impact of acute HIV infection (AHI) on ongoing HIV transmission among MSM. We will conduct network analyses and study linkage and retention in care after acute diagnosis as well as to examine the impact of “immediate” antiretroviral therapy on reducing onward HIV transmission. A second aim of this study is to conduct a RCT using extended-release naltrexone (XR-NTX) among MSM with alcohol use disorders who are newly diagnosed and to examine the impact of XR-NTX on retention in care, adherence, viral suppression and HIV transmission. We are also examining the impact of alcohol, drugs and neurocognitive impairment on HIV treatment outcomes as well as exploring mobile health technologies on improving HIV treatment outcomes. The second R01 is a comparative effectiveness trial comparing a pharmacotherapy versus a behavioral intervention for alcohol use disorders among HIV-infected MSM.