Community Mobilization to Improve the HIV/AIDS Continuum of Care Among Black Men

社区动员以改善黑人男性的艾滋病毒/艾滋病连续护理

• 批准号: 8604646
• 负责人: Susan M. KEGELES
• 金额: $ 60.11万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-12 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8604646
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; African American; Age; Anal Sex; Beryllium; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Collaborations; Communities; Continuity of Patient Care; Contracts; County; Cross-Sectional Studies; Data; Death Rate; Diffuse; Elements; Ethnography; Foundations; Frequencies; Funding; Goals; Grant; HIV; HIV Infections; Health; Health Services; Healthcare; Human immunodeficiency virus test; Incidence; Indium; Individual; Insurance; Intervention; Interview; Latino; Link; Logistics; Medical; Methods; Modeling; Outcome; Pharmaceutical Preparations; Primary Prevention; Public Health; Race; Randomized; Relative (related person); Research; Research Infrastructure; Resources; Risk Behaviors; Self Efficacy; Services; Social support; Testing; Texas; Time; Transportation; Unsafe Sex; Viral Load result; Work; aged; antiretroviral therapy; base; cohort; design; efficacy testing; empowered; empowerment; experience; improved; killings; literacy; men; men who have sex with men; prevent; programs; psychosocial; public health relevance; sexually active; social norm; social stigma; theories; transmission process

DESCRIPTION (provided by applicant): HIV rates are at catastrophic levels among young black men who have sex with men (YBMSM). A study in 21 US cities found that 21% of YBMSM aged 18-29 were HIV+, compared to 9% of Latino and 7% of white young MSM (YMSM), and these disparities are worsening. YBMSM are more likely to be HIV-infected, less likely to be aware of their HIV-infection, and less likely to disclose that they are HIV-infected, relative to men of other ethnic/racial groups. HIV+ YBMSM are also less likely than white MSM to be in treatment for HIV and to have undetectable viral loads (VLs). When HIV+ individuals achieve an undetectable VL, their own health improves, and they are also less infectious to others. Getting to that point, however, requires that HIV+ individuals: (1) know their HIV status; (2) link to HIV care; (3) stay in care over time; (4) begin appropriate treatment; and (5) adhere to antiretroviral therapy (ART). We refer to these steps as engagement in the HIV Care Continuum (CC). While these approaches have great potential to reduce HIV incidence, it is estimated that only 25% of HIV+ people in the US have engaged in the CC to the point of having undetectable VLs. Research suggests that HIV+ YBMSM engage in the CC far less than others. A community-level intervention (CLI) to build and mobilize communities of YBMSM to support HIV+ men to engage in the CC, decrease psychosocial barriers and increase psychosocial facilitators to engage in the CC within those communities may be an efficacious approach to prevent HIV transmission and improve health outcomes for YBMSM. This proposal will test the efficacy of such a CLI model, called United Black Element+ (UBE+). UBE+ will be an adaptation of a current CLI, called UBE. UBE has already engaged hundreds of YBMSM in Dallas TX, and it diffuses support for HIV prevention and creates positive social norms around reducing rates of unprotected sex and increasing regular HIV testing by building an empowered, mobilized YBMSM community. UBE+ will be an adaptation and extension of UBE designed to increase YBMSM's engagement in the CC. The aims of this project are: (1) To adapt and expand UBE into UBE+, a multilevel intervention that includes a new focus on increasing engagement in the CC among HIV+YBMSM, including targeting psychosocial barriers and facilitators to engaging in the CC that are experienced in this community (e.g., HIV stigma and social support); (2) To implement UBE+ in Dallas for 3 years in collaboration with a local AIDS Service Organization currently implementing UBE, the Dallas County Health Department, and the Texas Department of State Health Services' (TDSHS) HIV-STD Program; and (3) To evaluate the efficacy of UBE+ in increasing engagement in the CC in Dallas (utilizing Houston as a control community) using 2 independent methods: (a) a longitudinal cohort of HIV+ YBMSM providing data on engagement in care, and experiences of psychosocial and logistic barriers and facilitators to engagement in care; and (b) public health data that the TDSHS independently collects on HIV+ YBMSM's engagement in the CC.

描述（由申请人提供）：与男性发生性关系的年轻黑人（YBMSM）的艾滋病毒率处于灾难性水平。在美国21个城市进行的一项研究发现，21％的18-29岁YBMSM为HIV+，而Latino的9％和7％的白人年轻MSM（YMSM），这些差异恶化。 YBMSM更有可能感染HIV，不太可能意识到其HIV感染，并且相对于其他种族/种族群体的男人而言，他们不太可能透露其感染了HIV感染。 HIV+ YBMSM也比白色MSM接受HIV治疗，并且患有无法检测的病毒载荷（VLS）的可能性也小。当艾滋病毒+个人获得无法检测到的VL时，他们自己的健康就会改善，并且对他人的感染力也不太感染。但是，达到这一点需要艾滋病毒+个人：（1）知道他们的艾滋病毒状况； （2）链接到艾滋病毒护理； （3）随着时间的推移保持照顾； （4）开始适当的治疗； （5）遵守抗逆转录病毒 治疗（艺术）。我们将这些步骤称为参与艾滋病毒护理连续体（CC）。尽管这些方法具有降低艾滋病毒发病率的巨大潜力，但据估计，在美国，只有25％的艾滋病毒+患者参与了CC，直到无法检测到的VLS。研究表明，HIV+ YBMSM的参与率远低于其他CC。社区级干预（CLI），以建立和动员YBMSM社区支持HIV+男性参与CC，减少心理社会障碍并增加社会心理促进者以在这些社区中参与CC的情况，这可能是一种有效的方法，可以防止HIV传播并改善YBMMSM的健康状况。该建议将测试称为联合黑色元素+（UBE+）的这种CLI模型的功效。 UBE+将是当前CLI的改编，称为UBE。 UBE已经在达拉斯TX上激活了数百个YBMSM，它扩散了对预防艾滋病毒的支持，并围绕降低未受保护的性别率创造了积极的社会规范，并通过建立有能力的，动员的YBMSM社区来增加定期的HIV测试。 UBE+将是旨在增加YBMSM参与CC的UBE的改编和扩展。该项目的目的是：（1）将UBE适应UBE+，这是一种多层次干预措施，其中包括新的重点是增加HIV+YBMSM中CC的参与度，包括针对社区中经验丰富的心理社会障碍和促进者，以参与该社区中经历的CC（例如，HIV，HIV stigma和社会支持）； （2）与目前实施UBE，达拉斯县卫生部门和德克萨斯州州卫生服务部的当地艾滋病服务组织合作，在达拉斯实施UBE+ 3年。 （3）使用2种独立方法评估ube+在达拉斯（将休斯顿作为对照社区的CC参与）增加的功效：（a）HIV+ YBMSM的纵向同类群体提供有关关注的数据，以提供有关护理的参与，以及精神障碍和后勤障碍和辅助剂的经验，从而参与互动， （b）TDSHS独立收集HIV+ YBMSM参与CC的公共卫生数据。