Novel Stigma/Structural Interventions for Increasing HIV/STI Testing Among BMSM

增加 BMSM 中 HIV/STI 检测的新耻辱/结构性干预措施

• 批准号: 9357683
• 负责人: Lisa A Eaton
• 金额: $ 77.89万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-26 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9357683
• 关键词: AIDS prevention; Address; Anus; Appointment; Appointments and Schedules; Area; Caring; Centers for Disease Control and Prevention (U.S.); Communities; Continuity of Patient Care; Cost Savings; Counseling; Detection; Environment; Epidemic; Funding; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV/STD; Health; Home environment; Human immunodeficiency virus test; Incidence; Individual; Intervention; Intervention Trial; Mediating; Meta-Analysis; Modeling; Outcome; Persons; Population; Prevalence; Randomized; Reporting; Request for Applications; Research; Research Proposals; Resources; Risk; Risk Factors; Risk Reduction; Schedule; Self-Administered; Services; Site; Structural Models; Testing; United States; Work; base; black men who have sex with men; community based participatory research; cost; cost effectiveness; design; economic evaluation; experience; falls; follow-up; health care availability; improved; male; men' s group; novel; novel strategies; risk selection; social stigma; uptake

This application requests support to conduct structural and stigma-focused interventions to increase HIV and STI testing uptake among Black men who have sex with men (BMSM). Our research proposal is focused on this population due to the alarmingly high rates of HIV/STI among BMSM– this group has experienced elevated rates of HIV incidence and prevalence since the beginning of the US epidemic, and current estimates demonstrate that although BMSM make up only 0.2% of the population they make up 22% of new HIV infections. In our own work we have documented a 5.1% annual HIV incidence and a 35% HIV prevalence among BMSM. We are failing to engage BMSM at all points of the HIV care continuum including the seek and test components. The CDC recommends that individuals at substantial risk for HIV be tested for HIV/STI every three to six months; however, this goal is not being achieved and, therefore, a new approach to engaging BMSM is needed. To address these shortcomings and based on preliminary studies, we are proposing a 2 x 2 factorial design to evaluate a model that is aimed at increasing HIV/STI testing uptake among BMSM. We will test a stigma-focused intervention as stigma is a known deterrent to HIV/STI testing, yet little has been done to address this factor; and, we will evaluate HIV/STI test counseling delivered online (in conjunction with at-home HIV/STI test kits) as this delivery of testing may remove key barriers to reaching BMSM in need of HIV/STI related care services. Specific Aim 1: Assess HIV/STI testing uptake at scheduled HIV/STI test counseling appointments during the 12 month follow-up period. 500 BMSM who are HIV negative/unknown status, and report condomless anal intercourse with a male partner in past year and infrequent HIV/STI testing (≤1 HIV/STI test in past year) will be randomly assigned to one of four conditions: (a) receive CDC-based risk reduction counseling and scheduled for in-office HIV/STI test counseling appointments, (b) receive HIV stigma-enhanced intervention and scheduled for in-office HIV/STI test counseling appointments, (c) receive CDC-based risk reduction counseling and scheduled for online, via video calling, HIV/STI test counseling appointments, or (d) receive HIV stigma-enhanced intervention and scheduled for online, via video calling, HIV/STI test counseling appointments. Specific Aim 2: Evaluate mediating (key theoretical stigma variables) factors collected via assessments at 3, 6, and 12 month follow-ups. Specific Aim 3: Conduct an economic evaluation to determine the costs of the office-based and online-based HIV/STI test delivery formats from both a community-based payer perspective and a comprehensive societal perspective that includes all costs. Our project has the potential to exert a sustained and powerful impact not only on approaches to engaging BMSM, but to improving HIV/STI testing uptake which will likely improve multiple health outcomes among BMSM. If effective, our approach to improving HIV/STI testing uptake would be available for dissemination immediately and would fit within resource limited settings such as community based organizations and health departments.

该申请要求支持进行结构和污名的干预措施，以增加HIV和STI 测试与男性发生性关系的黑人（BMSM）的吸收。我们的研究建议重点是 人口由于BMSM中HIV/STI的高度高而引起的人口 - 该群体经历了升高 艾滋病毒事件的发生率和患病率以来美国流行病和当前的估计 证明，尽管BMSM仅占占新艾滋病毒感染的22％的人口的0.2％。 在我们自己的工作中，我们记录了BMSM中每年5.1％的HIV事件和35％的HIV患病率。 我们未能在包括寻求和测试组件在内的HIV护理连续体的所有角度参与BMSM。 疾病预防控制中心建议每三到六个人对艾滋病毒的艾滋病毒均有很大的艾滋病毒风险进行测试 月份；但是，这一目标并没有实现，因此，一种吸引BMSM的新方法是 需要。为了解决这些缺点并基于初步研究，我们提出了2 x 2阶乘 设计旨在评估旨在增加BMSM中HIV/STI测试摄取的模型。我们将测试 以污名为中心的干预是污名是已知的艾滋病毒/STI测试的确定，但几乎没有做任何事情 解决这个因素；而且，我们将评估在线交付的HIV/STI测试共同用于（与家用有关 HIV/STI测试套件）由于这种测试的交付可能会消除到达需要HIV/STI的BMSM的关键障碍 相关护理服务。特定目的1：评估计划的HIV/STI测试咨询中的HIV/STI测试吸收 在12个月的随访期内的约会。 500 BMSM，艾滋病毒负面/未知状态，并且 在过去一年中报告与男性伴侣的避孕套肛门交往和不频繁的HIV/STI测试（≤1HIV/STI 过去一年的测试）将随机分配到四个条件之一：（a）接收基于CDC的风险降低 咨询并计划在办公室内艾滋病毒/STI测试咨询约会，（b）接受HIV污名化增强 干预并计划在办公室内艾滋病毒/STI测试咨询约会，（c）接受基于CDC的风险 减少咨询并安排在线，通过视频通话，艾滋病毒/STI测试咨询约会，或（d） 通过视频通话，艾滋病毒/STI测试共振，接收艾滋病毒污名增强干预措施，并安排在线进行在线 约会。特定目的2：评估通过 在3、6和12个月的随访中进行评估。特定目标3：进行经济评估以确定 这两种基于社区的付款人 观点和全面的社会观点，包括所有费用。我们的项目有可能 不仅对参与BMSM的方法产生持续和强大的影响，而且还可以改善HIV/STI 测试摄取，这可能会改善BMSM的多种健康状况。如果有效，我们的方法 改善HIV/STI测试吸收将立即发射，并且适合资源 有限的设置，例如基于社区的组织和卫生部门。