PrEP Up!: Understanding PrEP stigma to improve uptake among men who have sex with men

PrEP Up！：了解 PrEP 耻辱以提高男男性行为者的接受度

基本信息

批准号：
9754300
负责人：
CLARE L BARRINGTON
金额：
$ 18.39万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-15 至 2021-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9754300
关键词：
AIDS prevention Address Adherence Adult Affect Applied Research Awareness Brazil Cellular Phone Central America Cities Client Clinic Clinical Trials Communities Country Development Ecuador Ensure Faculty Focus Groups Guatemala HIV HIV Infections Health Health Promotion Health Services Intervention Interview Knowledge Latin America Latin American Logistics Mediating Methods Participant Persons Peru Prevalence Prevention strategy Process Randomized Research Role Sampling Series Services Sex Orientation Sexual Health Social Environment Social support Stereotyping Structure Students Surveys Technology Tenofovir Transportation Work base care providers care systems control trial cost effective design emtricitabine experience flexibility improved innovation insight mHealth men men who have sex with men personalized approach pre-exposure prophylaxis preference recruit scale up smartphone Application social social stigma uptake virtual

项目摘要

Project Summary/Abstract Men who have sex with men (MSM) are disproportionately affected by HIV in Guatemala. While national level adult HIV prevalence is less than 1.0%, the most recent prevalence estimate among MSM is 10.5%. This dramatic HIV disparity suggests that current prevention strategies are not sufficient. Pre-Exposure Prophylaxis (PrEP) with daily tenofovir/emtricitabine safely provides high levels of protection against HIV infection if taken correctly and has expanded the HIV prevention landscape. Global PrEP uptake has been slower than expected, however, and PrEP acceptability among men who have sex with men (MSM) is only 58%1. Promoting PrEP requires innovative, tailored approaches grounded in contextualized understanding of the social context and lived experiences of potential users1,2. Among MSM, multiple levels of intersecting stigma related to HIV and sexual orientation can deter PrEP initiation1–14. PrEP stigma, which includes negative stereotypes of PrEP users as having HIV and/or being irresponsible and promiscuous, also greatly inhibits PrEP acceptability and uptake11,13–24. More research on levels and manifestations of PrEP stigma are needed to inform global PrEP promotion efforts. Mobile Health (mHealth) interventions, in particular smartphone applications (apps), can be used to mitigate stigma. The accessibility, affordability, flexibility, and anonymity of smartphones make them a highly appealing medium for engaging MSM and addressing PrEP stigma. Further, smartphone interventions address issues such as transportation logistics, stigma, and confidentiality, all of which are barriers to sexual health services among MSM in Guatemala6–9. While still a nascent field, early evidence, including work by our team, suggests that smartphone apps can address stigma as a barrier to health promotion among MSM by providing information and cultivating social support25–30. Our community research partner, Colectivo Amigos Contra el SIDA (CAS), opened the first community-based PrEP clinic in Latin America in January 2016 and is now planning to scale up coverage. This scale up creates a crucial need for information on barriers to PrEP acceptability and uptake and a unique opportunity to explore PrEP stigma in the lives of MSM. The proposed R21 aims to assess the role of stigma in PrEP acceptability to inform the design of mHealth PrEP promotion strategies through a bidirectional process of research capacity building with UNC and CAS. In Aim 1, we will determine the association between PrEP stigma and PrEP acceptability among MSM using a mixed methods approach. We will conduct qualitative in-depth interviews (n=20) and a structured survey (n=200) to obtain multiple perspectives on PreP acceptability, PrEP stigma, and smartphone use and preferences. For Aim 2, we will assess how MSM in Guatemala interact in online discussions and exchange social support related to PrEP through online focus groups discussions. For Aim 3, we will evaluate strategies to promote uptake of and engagement with a smartphone app for PrEP uptake. In these discussions we will assess optimal channels and messaging for app dissemination and components within the app to promote engagement.

项目概要/摘要在危地马拉，男男性行为者（MSM）在全国范围内受艾滋病毒影响的比例不成比例。成人艾滋病毒感染率低于 1.0%，MSM 中最新的感染率估计为 10.5%。巨大的艾滋病毒差异表明目前的预防策略还不够。每天服用替诺福韦/恩曲他滨 (PrEP) 可以安全地提供高水平的艾滋病毒感染保护正确地扩大了艾滋病毒预防领域的全球范围，其采用速度比预期要慢，然而，男男性行为者 (MSM) 对 PrEP 的接受度仅为 58%1。需要以对社会背景的具体理解为基础的创新、量身定制的方法潜在使用者的生活经历1,2 在 MSM 中，与艾滋病毒和艾滋病相关的多重交叉耻辱感。性取向可以阻止 PrEP 的启动1-14，其中包括对 PrEP 使用者的负面刻板印象。感染 HIV 和/或不负责任和滥交，也会极大地抑制 PrEP 的可接受性和需要对 PrEP 耻辱程度和表现进行更多研究，以便为全球 PrEP 提供信息。移动健康（mHealth）努力干预措施，特别是智能手机应用程序（apps），可以是智能手机的可访问性、可负担性、灵活性和匿名性使其成为一种耻辱。智能手机干预是吸引 MSM 参与和解决 PrEP 耻辱问题的极具吸引力的媒介。解决运输物流、耻辱和保密等问题，所有这些都是性障碍危地马拉 MSM 的卫生服务虽然仍是一个新兴领域，但早期证据，包括我们的工作。团队建议，智能手机应用程序可以通过以下方式解决 MSM 健康促进障碍中的耻辱问题：提供信息并培养社会支持25-30 我们的社区研究合作伙伴 Colectivo Amigos。 Contra el SIDA (CAS) 于 2016 年 1 月在拉丁美洲开设了第一家基于社区的 PrEP 诊所，现在计划扩大覆盖范围，因此迫切需要有关 PrEP 障碍的信息。可接受性和采用率，以及探索 MSM 生活中 PrEP 耻辱的独特机会。 R21 旨在评估耻辱感在 PrEP 可接受性中的作用，为 mHealth PrEP 推广设计提供信息在目标 1 中，我们将通过与 UNC 和 CAS 的双向研究能力建设来制定战略。使用混合方法确定 MSM 中 PrEP 污名与 PrEP 可接受性之间的关联我们将进行定性深入访谈（n=20）和结构化调查（n=200），以获取有关 PreP 可接受性、PrEP 耻辱以及智能手机使用和偏好的多种观点。 2、我们将评估危地马拉的MSM如何在在线讨论中互动并交换社会支持对于目标 3，我们将通过在线焦点小组讨论评估与 PrEP 相关的策略。在这些讨论中，我们将评估 PrEP 智能手机应用程序的使用情况和参与度。应用程序传播和应用程序内组件的最佳渠道和消息传递，以促进参与。