Recombinant HIV-2 Gp160 Protein (ST)

Mentoring relationships are characterized by a sustained, high quality, and skill-building relationship between a protege and mentor (Handbook of Youth Mentoring, Los Angeles, SAGE, 2014). Within prevention science, youth mentoring programs emphasize creating a specific context that benefits a young person. Program-sponsored relationships between youth and adults allow for creating a mentor-mentee partnership, but do not require the establishment of a strong bond in order to deliver prevention-focused activities and experiences (Handbook of Youth Mentoring, Los Angeles, SAGE, 2014). Motivational Interviewing (MI) is a counseling style used widely to promote health behavior change and in prevention interventions. As part of an upstream approach to HIV prevention, we combined mentoring and MI by training peer mentors to use MI skills in their interactions as part of a large RCT of a mobile life skills intervention for adolescent men who have sex with men (AMSM). Our training model developed for training peer mentors in MI skills resulted in peers reaching and exceeding established MI fidelity thresholds (e.g., mean percentage of complex reflections = 80%, mean reflection to question ratio = 2.2:1). We offer reflections on lessons learned and future directions for those researchers and practitioners who may benefit from adapting this blended approach for mentoring AMSM.

Background: Long-acting (LA) injectable regimens are a potential therapeutic option in people living with HIV-1. Setting: ATLAS (NCT02951052) and FLAIR (NCT02938520) were 2 randomized, open-label, multicenter, multinational phase 3 studies. Methods: Adult participants with virologic suppression (plasma HIV-1 RNA <50 copies/mL) were randomized (1:1) to continue with their current antiretroviral regimen (CAR) or switch to the long-acting (LA) regimen of cabotegravir (CAB) and rilpivirine (RPV). In the LA arm, participants initially received oral CAB + RPV once-daily for 4 weeks to assess individual safety and tolerability, before starting monthly injectable therapy. The primary endpoint of this combined analysis was antiviral efficacy at week 48 (FDA Snapshot algorithm: noninferiority margin of 4% for HIV-1 RNA >= 50 copies/mL). Safety, tolerability, and confirmed virologic failure (2 consecutive plasma HIV-1 RNA >= 200 copies/mL) were secondary endpoints. Results: The pooled intention-to-treat exposed population included 591 participants in each arm [28% women (sex at birth), 19% aged >= 50 years]. Noninferiority criteria at week 48 were met for the primary (HIV-1 RNA >= 50 copies/mL) and key secondary (HIV-1 RNA <50 copies/mL) efficacy endpoints. Seven individuals in each arm (1.2%) developed confirmed virologic failure; 6/7 (LA) and 3/7 (CAR) had resistance-associated mutations. Most LA recipients (83%) experienced injection site reactions, which decreased in incidence over time. Injection site reactions led to the withdrawal of 6 (1%) participants. The serious adverse event rate was 4% in each arm. Conclusion: This combined analysis demonstrates monthly injections of CAB + RPV LA were noninferior to daily oral CAR for maintaining HIV-1 suppression.