Development and Feasibility Testing of a Multi-Component Intervention to Increase HIV Testing and Linkage to Services among MSM in Peru

多成分干预措施的开发和可行性测试，以加强秘鲁男男性行为者之间的艾滋病毒检测和服务联系

• 批准号: 10450045
• 负责人: Alexander Julian Lankowski
• 金额: $ 18.7万
• 依托单位: FRED HUTCHINSON CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10450045
• 关键词: AIDS prevention; Address; Adherence; Alcohol consumption; Area; Attitude; Automation; Automobile Driving; Caring; Clinic; Clinical Research; Communities; Complement; Consolidated Framework for Implementation Research; Continuity of Patient Care; Development; Development Plans; Diagnosis; Elements; Exposure to; Focus Groups; Goals; HIV; HIV Infections; HIV Seronegativity; HIV diagnosis; Health Personnel; Health Services Accessibility; Home; Hour; Human immunodeficiency virus test; Incidence; Individual; Institution; International; Intervention; Intervention Trial; Interview; Language; Link; Logistics; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Multimedia; Nature; Newly Diagnosed; Outcome; Output; Participant; Peru; Population; Positioning Attribute; Prevention; Privacy; Provider; Quantitative Evaluations; Research; Research Personnel; Resources; Risk; Sauna; Scheme; Security; Services; Site; Standardization; Structure; Target Populations; Technology; Testing; Text; Time; Training; Vulnerable Populations; Work; antiretroviral therapy; barrier to care; base; career; career development; comparative; cost; digital; evidence base; experience; feasibility testing; feasibility trial; field study; implementation barriers; implementation facilitators; implementation science; improved; mHealth; men who have sex with men; multi-component intervention; multidisciplinary; novel; outreach; point of care testing; pre-exposure prophylaxis; preference; prevention service; primary outcome; recruit; scale up; secondary outcome; self testing; service intervention; sex; sexual risk behavior; social; theories; therapy development; transmission process; treatment services; two way texting; uptake; usability; user-friendly; web portal

SUMMARY/ABSTRACT Despite the scale-up of free antiretroviral treatment (ART), HIV incidence among men who have sex with men (MSM) in Perú remains high. Delayed diagnosis and suboptimal linkage to care are two important factors driving onward transmission. New strategies to increase rates of testing and promote timely linkage to HIV treatment and prevention are greatly needed. Venue-based testing and mobile health (mHealth) are two promising strategies that could address these challenges by mitigating key barriers to care experienced by MSM in Perú. Based on our previous work, offering HIV testing at social venues (e.g. bars/discos, public plazas) in Lima is acceptable and identifies MSM with previously undiagnosed HIV infection. Extending this to sex-on-premises venues (SOPVs: saunas, sex clubs, hourly hotels) could reach a particularly vulnerable sub-population of MSM, including those not reached by clinic-based testing. One potential pitfall of venue-based HIV testing is low linkage to care among newly diagnosed HIV+ individuals. WelTel is an evidence-based mHealth platform that may be well-suited to assist by adapting its theory-guided two-way messaging approach to support linkage to care – and prevention – among MSM reached for HIV testing at SOPVs. In this proposal we will develop, refine, and conduct feasibility testing of a multi-component HIV testing and linkage-to-services intervention for MSM in Perú, consisting of two core components: 1) SOPV-based HIV testing and 2) “AppSalud”, a novel tailored application of WelTel to facilitate linkage to HIV services. In AIM 1, we will conduct formative research with the target population and key stakeholders to guide development of the intervention. In AIM 2, we will develop AppSalud by reconfiguring WelTel with new tailored content, then beta test it with both potential user types: (a) MSM, and (b) providers at HIV clinics in Lima (to test the provider interface). Guided by the “mCFIR”, a mHealth- specific version of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed methods analysis exploring potential implementation barriers and facilitators for AppSalud from the perspectives of both MSM and providers. In AIM 3, we will conduct a feasibility trial of the multi-component intervention (SOPV- based HIV testing plus AppSalud), comparing 3 HIV testing formats: rapid point-of-care testing (POCT), home based self-testing (HBST), and referral for clinic-based testing (RCBT). Supported by a team of experienced international HIV investigators and outstanding institutions in both the U.S. and Perú, these studies constitute the mentored clinical research component of the candidate’s career development plan. In parallel with this research, the candidate will pursue additional training in implementation science, qualitative/mixed methods, mHealth, and intervention trials, guided by a multidisciplinary team of committed mentors with expertise in each of these areas. The training and mentored research made possible by this K23 Award will launch the candidate’s career as an independent investigator poised to achieve his long-term goal of becoming a leading HIV researcher developing evidence-based strategies to optimize HIV prevention and care globally.

摘要/摘要 尽管自由抗逆转录病毒治疗（ART）扩大了，但与男性发生性关系的男性发生了艾滋病毒 （MSM）在秘鲁仍然很高。延迟诊断和与护理的次优连接是驱动的两个重要因素 向内传输。提高测试速率并促进及时与艾滋病毒治疗联系的新策略 非常需要预防。基于场地的测试和移动健康（MHealth）是两个承诺 通过减轻MSM在佩鲁经历的关键障碍，可以解决这些挑战的策略。 根据我们以前的工作，在利马提供社交场所（例如酒吧/迪斯科舞厅）的艾滋病毒测试是 可接受的并鉴定MSM先前未诊断的HIV感染。将其扩展到性交 场地（SOPV：桑拿，性俱乐部，每小时酒店）可能会达到特别脆弱的MSM子人群， 包括基于诊所的测试未达到的那些。基于场地的艾滋病毒测试的一个潜在陷阱是低连接 在新诊断的艾滋病毒+个人中照顾。 Weltel是一个基于证据的MHealth平台 非常适合通过调整其理论引导的双向消息传递方法来支持与Care的联系，并 预防 - 在MSM中，在SOPV上进行HIV测试。在此提案中，我们将开发，完善，并 对MSM进行多组分HIV测试和连锁与服务干预的可行性测试 在秘鲁中，由两个核心组成部分组成：1）基于SOPV的HIV测试和2）“ Appsalud”，这是一种量身定制的小说 Weltel的应用以促进与艾滋病毒服务的联系。在AIM 1中，我们将与 目标人群和主要利益相关者指导干预的发展。在AIM 2中，我们将发展 Appsalud通过将Weltel与新的量身定制内容重新配置，然后使用两个潜在用户类型进行测试：（a） MSM和（b）利马艾滋病毒诊所的提供者（测试提供者界面）。在MHealth的“ McFir”的指导下 - 实施研究的合并框架（CFIR）的特定版本，我们将进行混合 方法分析从角度探索Appsalud的潜在实现障碍和促进者 MSM和提供商的。在AIM 3中，我们将对多组分干预措施进行可行性试验（SOPV- 基于HIV测试加上Appsalud），比较3种HIV测试格式：快速护理测试（POCT），家庭 基于临床测试（RCBT）的基于自测（HBST）和转诊。在经验团队的支持下 这些研究构成了美国和佩鲁的国际艾滋病毒研究者和杰出机构 候选人职业发展计划的临床研究部分。与此并行 研究，候选人将接受实施科学，定性/混合方法的其他培训， MHealth和干预试验由具有专业知识的多学科团队的指导 这些区域中的每一个。该K23奖项实现的培训和修改研究将启动 候选人作为独立调查员的职业毒死了，实现了自己成为领先的长期目标 艾滋病毒研究人员制定了基于证据的策略，以在全球范围内优化艾滋病毒预防和护理。