Brief, web-based intervention to reduce heavy drinking and encourage prevention among high-risk men completing HIV/STI self-testing

基于网络的简短干预措施，以减少酗酒并鼓励完成艾滋病毒/性传播感染自我检测的高危男性进行预防

• 批准号: 10207340
• 负责人: Tyler Blake Wray
• 金额: $ 31.87万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10207340
• 关键词: AIDS prevention; Address; Adopted; Adoption; African American; Alcohol abuse; Alcohol consumption; Alcoholic beverage heavy drinker; Alcohols; Anal Sex; Area; Baltimore; Caring; Centers for Disease Control and Prevention (U.S.); Chlamydia; Cities; Clinic; Communities; Counseling; Data; Diagnostic Reagent Kits; District of Columbia; Effectiveness; Ensure; Event; Focus Groups; Future; Genital; Genitalia; Goals; Guidelines; HIV; HIV Infections; HIV Seronegativity; HIV diagnosis; HIV risk; Heavy Drinking; Hispanics; Home; Hour; Human immunodeficiency virus test; Hybrids; Incidence; Infection; Intervention; Interview; Latino; Link; Los Angeles; Methods; Modeling; Online Systems; Participant; Population; Prevention; Prevention approach; Prevention program; Randomized; Randomized Controlled Trials; Reporting; Risk; Risk Factors; Risk Reduction; Services; Sex Behavior; Sexual Partners; Sexually Transmitted Diseases; Site; Surveys; Syphilis; Test Result; Testing; Time; United States; Universities; Unsafe Sex; Viral; Work; alcohol misuse; alcohol related problem; alcohol research; base; behavior change; binge drinking; brief intervention; brief motivational intervention; condomless anal sex; design; drinking; evidence base; follow-up; high risk; high risk men; implementation outcomes; improved; infection risk; innovation; men who have sex with men; mortality; motivational enhancement therapy; outreach program; pharyngeal gonorrhea; phosphatidylethanol; pre-exposure prophylaxis; prevent; programs; recruit; rectal; response; sample collection; satisfaction; screening; self testing; sex; sex risk; sexual HIV transmission; sexual risk behavior; theories; tool; uptake; virtual; web app; web-based intervention

Project Summary/Abstract In the United States, rates of new HIV infections have remained stable among men who have sex with men (MSM) in recent years despite declines among most other at-risk groups, highlighting the continued need for innovative approaches to prevention for MSM. Alcohol use is a major risk factor for HIV infection among MSM, in part due to the tendency for heavy drinking to increase the odds of engaging in sex that can transmit HIV. Our work has also shown that heavy drinkers are less likely to have tested for HIV within CDC-recommended intervals. This level of drinking is common among MSM, with up to 40% reporting heavy drinking in the past month. Home-based HIV and STI self-testing is a promising strategy for encouraging regular testing. Regular testing can help detect more new infections earlier, preventing onward infections and improving mortality. Despite self-testing’s promise, little is known about the best ways to provide support alongside HIV/STI self- testing programs. Although many current self-testing programs provide recipients with access to a 24-hour helpline they can call for counseling and referrals, few use this service. The counseling provided is also rarely informed by theory and often does not address key factors that maintain risk, like alcohol use. Web-based, brief interventions may be one approach that is well-suited to provide support alongside these programs and could help MSM participating in these programs to reduce their alcohol use and begin using HIV prevention methods that work. With previous support, we developed Game Plan, an interactive, responsive web application modeled after evidence-based brief motivational interventions. It is designed to help high-risk, heavy drinking MSM consider reducing their binge drinking and sexual risk behavior when they get tested for HIV. In a preliminary study of 40 heavy drinking, high-risk MSM, those who used Game Plan after HIV testing reported 24% fewer binge drinking days, 17% fewer alcohol problems, 50% fewer new anal sex partners, and 12% fewer high-risk condomless sex (CAS) acts compared to controls over a three-month follow-up period. The proposed study involves conducting a larger-scale study exploring Game Plan’s effects among MSM in the real-world, alongside innovative approaches for expanding HIV testing. Using a hybrid 1 effectiveness- implementation approach, we will recruit 360 high-risk, heavy drinking MSM online from several high-incidence areas in the US to participate in a program providing home-based HIV/STI self-tests in the mail at regular intervals over a year (baseline, 6 months, 12 months). Participants will be randomly assigned to receive access to either (1) a 24-hour helpline for counseling/referrals, or (2) the helpline plus Game Plan. We will test whether those who use Game Plan show lower rates of heavy drinking, any STIs, and high-risk CAS events compared to those receiving access to the helpline alone. Mixed-methods approaches will also be used with Game Plan users (N=30) and testing outreach program stakeholders (N=12) to begin understanding key implementation outcomes that can guide us in designing strategies for implementing Game Plan into HIV/STI testing programs.

项目概要/摘要 在美国，男男性行为者中新发艾滋病毒感染率保持稳定 尽管大多数其他高危人群的数量有所下降，但近年来（MSM）的数量有所下降，这凸显了持续需要 预防 MSM 的创新方法。饮酒是 MSM 感染艾滋病毒的一个主要危险因素， 部分原因是酗酒会增加传播艾滋病毒的性行为的可能性。 我们的工作还表明，酗酒者在 CDC 推荐的范围内进行艾滋病毒检测的可能性较小 这种程度的饮酒在 MSM 中很常见，高达 40% 的人表示过去曾大量饮酒。 家庭艾滋病毒和性传播感染自我检测是鼓励定期检测的有效策略。 检测可以帮助及早发现更多新感染，防止进一步感染并降低死亡率。 尽管自我检测有希望，但人们对在艾滋病毒/性传播感染自我检测的同时提供支持的最佳方法知之甚少。 尽管当前许多自我测试计划都为接受者提供了 24 小时的访问权限。 他们可以拨打热线电话寻求咨询和转介，但很少有人使用这项服务。所提供的咨询也很少。 受理论启发，通常不会解决维持风险的关键因素，例如基于网络的饮酒， 简短的干预可能是一种非常适合与这些计划一起提供支持的方法， 可以帮助 MSM 参与这些计划减少饮酒并开始预防艾滋病毒 在之前的支持下，我们开发了 Game Plan，一个交互式、响应式的网络。 该应用程序以基于证据的简短动机干预为模型，旨在帮助高风险、 酗酒的男男性接触者在接受检测时考虑减少酗酒和性危险行为 在一项针对 40 名酗酒、高危 MSM 的初步研究中，这些人在 HIV 检测后使用了 Game Plan。 据报告，酗酒天数减少了 24%，酒精问题减少了 17%，新肛交伴侣减少了 50%， 在三个月的随访期内，与对照组相比，高风险无套性行为 (CAS) 行为减少了 12%。 拟议的研究涉及进行一项更大规模的研究，探讨游戏计划对 MSM 的影响 现实世界，以及使用混合 1 有效性扩大艾滋病毒检测的创新方法。 实施办法，我们将从几个高发区网上招募360名高危、酗酒的MSM 美国的一些地区参加一项计划，定期通过邮件提供家庭艾滋病毒/性传播感染自我检测 一年内的间隔（基线、6 个月、12 个月）。参与者将被随机分配接受访问。 (1) 24 小时咨询/转介帮助热线，或 (2) 帮助热线加游戏计划 我们将测试是否。 与使用 Game Plan 的人相比，酗酒、任何性传播感染和高风险 CAS 事件的发生率较低 对于那些仅使用帮助热线的人，混合方法也将与游戏计划一起使用。 用户 (N=30) 和测试外展项目利益相关者 (N=12) 开始了解关键实施 这些结果可以指导我们设计将游戏计划实施到艾滋病毒/性传播感染检测项目中的策略。