Increasing PrEP Use in High-Risk Social Networks of African American MSM in Underserved Low-Uptake Cities

在服务不足、使用率低的城市中，增加非洲裔美国男男性接触者高风险社交网络中 PrEP 的使用

基本信息

批准号：
10200891
负责人：
Yuri A Amirkhanian
金额：
$ 66.05万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-21 至 2023-06-30
项目状态：
已结题

项目摘要

Abstract PrEP is a powerful and potentially groundbreaking HIV prevention strategy, but its public health impact will depend on widescale adoption by persons at greatest risk for contracting HIV infection. PrEP awareness and use remain especially low among African American MSM in mid-sized cities across the center of the country, and very little research has tested interventions that can increase PrEP awareness, benefit perception, and normative support—and decrease PrEP stigma and concerns—among African American MSM in these cities. PrEP can achieve its full public health potential only when its uptake among racial minority MSM in neglected mid-sized American cities is increased. In prior research, our team established that network-level interventions can reach and be used to deliver effective HIV risk reduction interventions to Black MSM in the industrial Midwest, including hard-to-reach men hidden in the community. The planned mixed- methods research will now evaluate a network intervention to increase PrEP uptake among high-risk African American MSM in Milwaukee and Cleveland, cities where HIV racial disparities are profound but PrEP use is low. In a formative research phase, in-depth interviews will be conducted with African American MSM, PrEP providers, and other key informants in each city to identify understandings, concerns, barriers, and facilitators of PrEP use. In the main intervention trial phase, 36 social networks of high-risk racial minority MSM (expected n=504 participants) will be enrolled, 18 networks per city, by recruiting high-risk initial “seeds,” members of each seed's MSM friendship network, and then two outward successive rings of their friends. All study participants will receive baseline counseling for PrEP and risk reduction. The 36 networks will then be randomized in equal numbers to intervention and comparison conditions. In each intervention condition network, a cadre of network leaders open to PrEP, trusted for advice, and highly interconnected with others will attend an intervention that educates and then provides training and guidance in diffusing messages to friends to encourage PrEP uptake, correcting PrEP misconceptions and stigma, and instilling positive PrEP norms and benefit perceptions. At baseline and 6- and 15-month followup points, participants will complete measures of PrEP use corroborated by the testing of dried blood spot specimens for tenofovir; measures of PrEP related knowledge, attitudes, perceived norms, and stage of change readiness; sexual risk practices; and substance use. We hypothesize that the network intervention will produce greater PrEP adoption by HIV- participants than that found in comparison networks. PrEP knowledge, attitudes, intentions, peer norms, and stage of change readiness will be explored as both mediators and as secondary outcomes. Intervention effects on HIV incidence will be mathematically modeled to determine its public health impact. This research will test a novel approach for increasing PrEP use among neglected racial minority MSM in mid-sized American cities who can best—and can perhaps only—be reached through their social network connections.

抽象的 PREP是一种强大且潜在的开创性的艾滋病毒预防策略，但其公共卫生影响将取决于患艾滋病毒感染风险最大的人的广泛采用。准备意识并在整个中心的中型城市中的非裔美国人MSM中保持尤其低国家，很少的研究测试了可以提高预科意识的干预措施，从而受益非裔美国人MSM的感知和正常支持，并减少准备污名和关注点在这些城市。只有在少数族裔中吸收其占用在被忽视的中型美国城市中的MSM增加了。在先前的研究中，我们的团队确定网络级干预措施可以达到并用于为黑人提供有效的HIV风险降低干预措施中西部工业的MSM，包括隐藏在社区中的难以触及的男人。计划的混合方法研究现在将评估网络干预，以增加非洲高风险非洲的预备在密尔沃基和克利夫兰的美国MSM，艾滋病毒种族差异的城市深远，但准备使用是低的。在形成性研究阶段，将对非裔美国人MSM进行深入的访谈提供者和每个城市中的其他关键信息，以确定理解，关注，障碍和促进者准备使用。在主要干预试验阶段，36个高风险种族少数民族MSM的社交网络（预期n = 504名参与者）将通过招募高风险的初始“种子”来招募每个城市的18个网络每个种子的MSM友谊网络的成员，然后是两个外在的朋友的成功戒指。全部研究参与者将获得基准咨询，以减少准备和风险。 36个网络将是以相等数量的方式随机分配干预和比较条件。在每个干预条件下网络，网络领导者的干部开放，可信赖，寻求建议，并与他人高度互连参加教育并提供培训和指导的干预措施，以扩散向朋友传播消息鼓励采取预期，纠正预期概念和污名，并灌输积极的准备规范和利益感知。在基线以及6个月和15个月的随访点，参与者将完成测量通过测试替诺福韦的干血点标本来证实的PREP使用；与准备相关的度量知识，参加者，感知规范和变革准备的阶段；性风险实践；和主题使用。我们假设网络干预将产生艾滋病毒参与者的更多准备比在比较网络中发现的那样。准备知识，参加者，意图，同伴规范和阶段变更准备就绪将作为调解人和次要结果探讨。干预对艾滋病毒的影响发病率将以数学建模来确定其公共卫生影响。这项研究将测试小说在美国中型城市中，可以增加被忽视的种族少数MSM的准备使用方法的方法最好的，并且可能只能通过他们的社交网络连接到达。