Peer-driven Intervention to Seek, Test & Treat Heterosexuals at High Risk for HIV

同伴驱动的干预寻求、测试

• 批准号: 8302233
• 负责人: Marya Gwadz
• 金额: $ 212.97万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-15 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8302233
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adult; African American; Alcohol or Other Drugs use; Appointment; Area; Attention; Behavior Therapy; Behavioral; Caring; Clinic; Clinical; Complement; Diagnosis; Epidemic; Future; Geographic Locations; Geography; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV-2; Health; Heterosexuals; Highly Active Antiretroviral Therapy; Human immunodeficiency virus test; Individual; Infection; Intervention; Intervention Studies; Latino; Learning; Link; Location; Measures; Mediating; Methodology; Minority Groups; Modeling; New York City; Newly Diagnosed; Participant; Persons; Pharmaceutical Preparations; Population; Positioning Attribute; Poverty; Prevalence; Protocols documentation; Regulation; Relative (related person); Reporting; Research; Respondent; Risk; Sampling; Signal Transduction; Stigmata; Testing; Time; Treatment outcome; United States; Viral Load result; base; binge drinker; comparative efficacy; computerized; cost; cost effective; cost effectiveness; design; experience; high risk; innovation; peer; racial and ethnic disparities; response; social; social stigma; surveillance study; theories; therapy design

DESCRIPTION (provided by applicant): Approximately 21% of HIV infections in the U.S. are undiagnosed, but only about 40% of all adults have been tested. Thus, late diagnosis of HIV is common, and, furthermore, treatment delays and disruptions are widespread. Heterosexuals at high risk (HHR) are significantly less likely to test for HIV, are more likely to be diagnosed with HIV late, and experience serious barriers to entering care compared to other groups. Our research team has studied HHR in New York City (NYC) as part of the CDC's National HIV Behavioral Surveillance (NHBS) studies. We found an HIV prevalence rate of 7.4% among HHR in NYC, and only 6% of these infections had been previously diagnosed. Further, in central Brooklyn, 10% were newly diagnosed with HIV. The proposed study will use NHBS methodology to target HHR. Reduced rates of HIV testing and treatment among HHR are due to structural (e.g., poor access), social (e.g., peer norms), and individual-level (e.g., low perceived risk) barriers. Thus active recruitment approaches modeled after NHBS are needed to overcome structural barriers, and peer-delivered interventions effectively reduce individual and social barriers to testing and treatment. The primary goal of the proposed study is to evaluate the efficacy of a multi-level enhanced peer-driven intervention (PDI) to seek, test, treat and retain HHR. The enhanced PDI is tailored specifically for HHR and includes computerized, navigation, and peer-delivered components to enhance future sustainability. The design of the intervention is guided by the Theories of Triadic Influence and Normative Regulation. Similar to NHBS, the enhanced PDI will use respondent-driven sampling (RDS). NHBS protocols use both venue-based sampling (VBS) and RDS for reaching populations at high risk. However, VBS and RDS have not yet been directly compared in terms of their yield of undiagnosed HIV infections. Thus the specific aims of this five-year proposed study are to: (1) compare the yield and efficiency of RDS and VBS to identify undiagnosed HIV infection among HHR; (2) measure the efficacy of an enhanced PDI compared to a control in terms of time to HIV care and HAART initiation, viral load suppression, and retention among those newly diagnosed; (3) examine whether the effects of the PDI on HIV health/treatment outcomes are mediated by changes in individual (e.g., perceived risk), social (e.g., peer norms), and structural influences (e.g., enhanced access), and/or whether other factors (e.g., substance use) moderate its effects; and (4) to project the costs and cost-effectiveness of RDS vs. VBS and PDI. We will conduct the enhanced PDI (N=3000) in central Brooklyn, a location hyperendemic for HIV and where HHR experience poor access to testing and treatment. Simultaneously, VBS (N=400) will be undertaken in central Brooklyn. The proposed study complements local and national HIV prevention initiatives and is designed to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. The vast majority of HHR are African-American or Latino; therefore the proposed study may also impact racial/ethnic disparities in HIV/AIDS.

描述（由申请人提供）：在美国，大约21％的艾滋病毒感染未被诊断，但只有大约40％的成年人已进行了测试。因此，艾滋病毒的晚期诊断很常见，此外，治疗延迟和中断是普遍的。高风险（HHR）的异性恋者对HIV进行测试的可能性明显较小，与其他组相比，更有可能被诊断为HIV迟到，并且经历了严重的进入护理的障碍。我们的研究团队已在纽约市（NYC）学习HHR，这是CDC国家艾滋病毒行为监测（NHBS）研究的一部分。我们发现纽约市HHR的HIV患病率为7.4％，此前只有6％的HHR已被诊断出。此外，在布鲁克林中部，有10％被新诊断出患有艾滋病毒。拟议的研究将使用NHBS方法来靶向HHR。 HHR中艾滋病毒测试和治疗率降低是由于结构性（例如访问不良），社交（例如，同伴规范）和个体级别（例如，感知的风险低）障碍。因此，需要以NHB为基础的主动招聘方法克服结构障碍，并有效地提供了分配干预措施，从而有效地减少了测试和治疗的个人和社会障碍。拟议的研究的主要目标是评估多级增强的同伴驱动干预措施（PDI）的疗效，以寻求，测试，治疗和保留HHR。增强的PDI专为HHR量身定制，包括计算机化，导航和同行分配的组件，以增强未来的可持续性。干预措施的设计取决于三合会影响力和规范性调节的理论。与NHB相似，增强的PDI将使用受访者驱动的采样（RDS）。 NHBS协议同时使用基于场地的采样（VB）和RDS来达到高风险的人群。但是，VBS和RD尚未根据未诊断的HIV感染产量直接比较。因此，这项为期五年的研究的具体目的是：（1）比较RDS和VBS的产量和效率，以鉴定HHR之间未诊断的HIV感染； （2）与对照在HIV护理和HAART启动，病毒载荷抑制以及在新诊断的人中的保留方面相比，测量增强PDI的功效； （3）检查PDI对HIV健康/治疗结果的影响是否是由个体（例如，感知风险），社会（例如，同伴规范）和结构影响（例如增强的访问）和/或其他因素（例如，物质使用）适应其影响的其他因素（例如增强的访问）以及是否适应其影响； （4）投影RDS与VBS和PDI的成本和成本效益。我们将在布鲁克林市中心进行增强的PDI（n = 3000），这是HIV的高流动性，HHR经历了无法获得测试和治疗的地方。同时，将在布鲁克林中部进行VBS（n = 400）。拟议的研究对地方和国家艾滋病毒的预防计划进行了补充，旨在为艾滋病毒预防投资组合提供高效，创新和可持续的多层次招募方法和干预。 HHR的绝大多数是非裔美国人或拉丁美洲人；因此，拟议的研究还可能影响艾滋病毒/艾滋病中的种族/族裔差异。