STAR-Seek, Test and Retain. Linkages for Black HIV+, Substance Using MSM

STAR-寻找、测试和保留。

• 批准号: 8452168
• 负责人: WAFAA M. EL-SADR
• 金额: $ 52.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 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/8452168
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Affect; African American; Age; Alcohol consumption; Alcohol or Other Drugs use; Behavior; CD4 Lymphocyte Count; Caring; Characteristics; Cities; Counseling; Diagnosis; Early Diagnosis; Education; Effectiveness; Epidemic; Ethnic group; Gays; General Population; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Human immunodeficiency virus test; Income; Individual; Infection; Intervention; Knowledge; Link; Mental disorders; Methods; New York City; Outcome; Participant; Patients; Population; Population Heterogeneity; Prevalence; Prevention; Primary Health Care; Public Health; Race; Randomized; Recruitment Activity; Respondent; Risk; Risk Behaviors; Sampling; Services; Social Characteristics; Target Populations; Test Result; Testing; Therapeutic; United States; Ursidae Family; Use Effectiveness; Visit; antiretroviral therapy; arm; cost; cost effectiveness; experience; financial incentive; high risk; innovation; men who have sex with men; novel; peer; prevent; prevention service; racial and ethnic; response; social stigma; success; transmission process

DESCRIPTION (provided by applicant): The HIV epidemic in the United States most severely affects men who have sex with men (MSM): 57% of all new infections occur in this population. Black MSM bear a disproportionate burden, with prevalence of 28%, in contrast to 19% in MSM overall. Black MSM undergo HIV testing less frequently than other MSM; are less likely to be aware that they are HIV infected; are more likely to experience delays in entry into HIV care; and are less likely to be prescribed ART when eligible. These disparities are pronounced in substance using MSM, as substance users are at elevated risk of late diagnosis and delayed engagement in HIV care. The combination of pervasive stigma associated with MSM behavior and high rates of substance use hinders effective prevention efforts in this population, even as the prevalence of infection in Black MSM in some US cities approaches 50%. Reducing HIV-related disparities in MSM and among Black Americans are National HIV/AIDS Strategy priorities and are essential to the effort to control and prevent HIV/AIDS in the US. Setting: The study will seek and recruit substance-using Black MSM in New York City for HIV testing and will link and retain those who are HIV-infected in HIV primary care. Study Aims: In response to the urgent public health need to seek substance-using Black MSM, identify those with HIV infection, and link the latter to HIV services, the study aims are as follows: Seek and Test: Respondent driven sampling (RDS) will be used to recruit substance-using Black MSM for HIV testing. RDS has been used in HIV surveillance among hard-to-reach populations and, to a limited extent, as a strategy for engaging hard-to-reach populations in services. We will assess the feasibility and effectiveness of using RDS to seek, recruit, and offer HIV testing to this high-risk population. Link and Retain: Participants with reactive rapid HIV test results and who are not currently in care will be randomized to two linkage and retention strategies: patient navigation (PN) and financial incentives (FI). One hundred participants will be randomized into each arm of the study. The primary objectives are: 1) to assess the feasibility and effectiveness of using RDS for seeking and recruiting substance-using Black MSM at high risk for HIV acquisition for rapid HIV counseling and testing; 2) to assess the feasibility and effectiveness of using two interventions, PN and FI, for linkage and retention in HIV care; and 3) to assess the cost-effectiveness of PN and FI for linkage and retention in HIV care. This study has the potential to identify effective methods to seek and test substance-using Black MSM, to link the HIV infected to services, and to retain them in care and treatment. The success of such an effort responds to priorities with the national HIV strategy. Results will inform innovative approaches to engaging highest-risk, difficult-to-reach individuals in HIV counseling and testing and retaining them in care and treatment.

描述（由申请人提供）：美国的艾滋病毒流行最严重影响与男性发生性关系的男性（MSM）：所有新感染的57％发生在该人群中。黑色MSM承担不成比例的负担，患病率为28％，而MSM总体上有19％。黑色MSM接受HIV测试的频率少于其他MSM。不太可能意识到它们是艾滋病毒感染的；更有可能体验进入艾滋病毒护理的延迟；符合条件时，不太可能被规定。这些差异使用MSM在物质中发音，因为药物使用者的诊断疗法的风险较高，并且参与艾滋病毒护理的延迟。与MSM行为相关的普遍污名和高率使用率的污名结合了该人群中有效的预防工作，即使在美国某些美国某些城市中，黑人MSM感染的普遍性接近50％。减少MSM和黑人美国人中与HIV相关的差异是国家艾滋病毒/艾滋病战略的重点，对于控制和防止美国的艾滋病毒/艾滋病至关重要。环境：该研究将在纽约市寻求并招募使用黑色MSM进行艾滋病毒测试，并将与艾滋病毒感染的HIV初级保健中感染的人联系并保留。研究目的：应对寻求使用黑色MSM的紧急公共卫生需求，确定艾滋病毒感染的人并将后者与艾滋病毒服务联系起来，该研究的目的如下：寻求和测试：受访者驱动的采样（RDS）将用于招募使用黑色MSM进行HIV测试的吸毒者。 RDS已用于难以到达的人群中的艾滋病毒监测，并在有限的范围内用作吸引难以到达服务的策略。我们将评估使用RDS寻求，招募和向这种高风险人群提供HIV测试的可行性和有效性。链接和保留：具有反应性快速艾滋病毒测试结果的参与者以及当前未受到护理的人将被随机分为两种连锁和保留策略：患者导航（PN）和经济激励措施（FI）。一百名参与者将被随机分为研究的每个部门。主要目标是：1）评估使用RDS寻求和招募使用物质的可行性和有效性，使用黑色MSM高风险获得HIV的高风险，以进行快速HIV咨询和测试； 2）评估使用两种干预措施PN和FI的可行性和有效性，以连接和保留HIV护理； 3）评估PN和FI在HIV护理中的联系和保留的成本效益。这项研究有可能确定寻求和测试使用黑色MSM的有效方法，将感染的HIV与服务联系起来，并将其保留在护理和治疗中。这样的努力的成功对国家艾滋病毒战略的重点做出了回应。结果将为创新的方法提供介绍，以吸引最高风险，难以到达的人参加艾滋病毒咨询，测试并将其保留在护理和治疗中。