Estimating the Impact of a Multilevel, Multicomponent Intervention to Increase Uptake of HIV Testing and Biomedical HIV Prevention among African?American/Black Gay, Bisexual and Same-gender Loving Men

评估多层次、多成分干预措施对提高非裔美国人/黑人同性恋、双性恋和同性男性对艾滋病毒检测和艾滋病毒生物医学预防的影响

• 批准号: 10484484
• 负责人: Keosha Tarheshia Bond
• 金额: $ 80.28万
• 依托单位: CITY COLLEGE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10484484
• 关键词: AIDS prevention; AIDS/HIV problem; Adherence; Affect; African American; Anxiety; Area; Behavior; Bisexual; Black American; Black Populations; Black race; Cognitive; Collaborations; Communities; Consult; Cox Proportional Hazards Models; Discrimination; Dissemination and Implementation; Empirical Research; Enrollment; Epidemic; Exposure to; Feedback; Feeling; Focus Groups; Fright; Fumarates; Gays; Gender; Geography; HIV; HIV Infections; Homophobia; Human immunodeficiency virus test; Immunoassay; Individual; Interruption; Intervention; Interview; Lateral; Length; Love; Measures; Media Campaign; Medical; Medical Records; Methods; Modeling; Motivation; Navigation System; Newly Diagnosed; Outcome; Patient Self-Report; Persons; Pharmaceutical Preparations; Population; Prevention; Printed Media; Quasi-experiment; Randomized; Research; Resistance; Self Care; Self Efficacy; Series; Services; Social support; Tenofovir; Testing; Time; Training; Trust; United States; Urine; aged; base; black men who have sex with men; coping; design; effectiveness testing; empowerment; evidence base; experience; four-arm study; high risk; implementation framework; interest; internalized stigma; intervention mapping; men; men who have sex with men; metropolitan; multi-component intervention; novel; peer; peer support; point of care testing; pre-exposure prophylaxis; preventive intervention; primary outcome; program dissemination; programs; racism; recruit; response; secondary outcome; self testing; service providers; side effect; skills; social; social media; social stigma; standard of care; uptake; urban area; urban dwelling; usability

ABSTRACT Increasing access to and uptake of biomedical prevention (PEP/PrEP) is critical to ending the epidemic in the United States (US) among gay, bisexual and other men who have sex with other men (MSM). This is particularly true for urban, African-American or Black MSM, who are disproportionately affected by HIV and would thus benefit from more HIV testing, which is now recommended every 3-6 months for key groups and is the gateway to treatment and prevention. NYC is the metropolitan area in the US with the largest number of newly diagnosed HIV infections among MSM and 89-94% of all people living with HIV/AIDS (PLWHA) in the US reside in urban areas. Although such urban areas often have robust testing and PEP/PrEP dissemination programs, consistent testing and PEP/PrEP uptake is unacceptably low among urban-dwelling Black MSM. There is thus a need for interventions to support both HIV testing and PEP/PrEP uptake by accelerating existing implementation and dissemination efforts. Most HIV testing and PEP/PrEP uptake interventions focus on individual-level navigation of system/structural barriers and/or cognitive antecedents (intentions, motivation, skills) to behavior; few focus on reducing stigma/discrimination-related barriers to testing/PEP/PrEP via self-testing, empowerment, peer support and community norms. To fill this gap, we propose to test an intervention composed of evidence-based and novel intervention components, designed by our study team, that operate at multiple levels and can be integrated into CBO-delivered HIV prevention programming to support HIV testing and PEP/PrEP uptake. We will estimate additive and interactive effects of the components, that include a single-session, peer-based HIV self-testing component, a three-session PEP/PrEP navigation enhancement component, and a social and print anti-intersectional stigma media campaign, using factorial and quasi-experimental designs. The primary outcomes are HIV testing (while not on PrEP/PEP) and PrEP uptake. Secondary outcomes include consistent HIV testing (2+ tests at least 3 months apart in 9 months); PEP uptake; PrEP/PEP adherence (self-report/medical record/urine test). To achieve the study aims, we will enroll 480 PrEP-eligible Black MSM (aged 18-55) living in Central Brooklyn into the study and randomize them to one of four study arms and follow them over 18 months. Our study, which represents a collaboration between a community-based organization currently engaged in PEP/PrEP uptake programming and an academic research team, is designed to identify the added value of components that operate at different levels and are designed to increase individual-level HIV testing and biomedical HIV prevention use among a group highly vulnerable to HIV.

抽象的 增加生物医学预防 (PEP/PrEP) 的获取和采用对于结束该流行病至关重要 美国 (US) 同性恋、双性恋和其他与其他男性发生性关系的男性 (MSM)。这一点特别 对于城市、非裔美国人或黑人男男性接触者来说确实如此，他们不成比例地受到艾滋病毒的影响，因此 受益于更多的 HIV 检测，现在建议重点人群每 3-6 个月进行一次检测，这是一个门户 来治疗和预防。纽约市是美国新增确诊人数最多的大都市区 美国 MSM 和 89-94% 的艾滋病毒/艾滋病感染者 (PLWHA) 中的艾滋病毒感染者居住在城市 地区。尽管这些城市地区通常有健全的检测和 PEP/PrEP 传播计划，但始终如一 居住在城市的黑人 MSM 的检测和 PEP/PrEP 接受率低得令人无法接受。因此需要 通过加速现有的实施和干预措施，支持艾滋病毒检测和 PEP/PrEP 的采用 传播努力。大多数 HIV 检测和 PEP/PrEP 采取干预措施都侧重于个人层面的导航 系统/结构障碍和/或行为的认知前因（意图、动机、技能）；很少有焦点 通过自我测试、赋权、同行减少与耻辱/歧视相关的测试/PEP/PrEP障碍 支持和社区规范。为了填补这一空白，我们建议测试一种基于证据的干预措施 以及由我们的研究团队设计的新颖的干预组件，它们在多个层面上运行，并且可以 纳入 CBO 实施的 HIV 预防规划，以支持 HIV 检测和 PEP/PrEP 的采用。我们 将估计各组成部分的累加和交互效应，其中包括单次、基于同伴的 HIV 自测试组件、三会话 PEP/PrEP 导航增强组件以及社交和打印组件 使用析因和准实验设计的反交叉耻辱媒体运动。初级 结果是 HIV 检测（而不是 PrEP/PEP）和 PrEP 摄取。次要结果包括一致 HIV 检测（9 个月内至少间隔 3 个月进行 2 次以上检测）； PEP 的吸收； PrEP/PEP 依从性（自我报告/医疗 记录/尿液测试）。为了实现研究目标，我们将招募 480 名居住在 布鲁克林中部参与研究，并将他们随机分配到四个研究组之一，并跟踪他们超过 18 个月。 我们的研究代表了目前从事的社区组织之间的合作 PEP/PrEP 吸收计划和学术研究团队旨在确定以下内容的附加值： 在不同级别上运行的组件，旨在增加个人级别的艾滋病毒检测和 在艾滋病毒高危人群中使用生物医学艾滋病毒预防。