Increasing HIV/STI Home Testing, Linkage to Care, and Linkage to PrEP via a Digital Intervention among Black Women in a Geographic Hotspot

通过对地理热点地区黑人妇女进行数字干预，增加 HIV/STI 家庭检测、与护理的联系以及与 PrEP 的联系

• 批准号: 10559293
• 负责人: Liesl A Nydegger
• 金额: $ 19.11万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-28 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10559293
• 关键词: AIDS prevention; Accounting; Adoption; Appointment; Area; Award; Behavior; Behavioral; Behavioral Model; Black race; COVID-19 pandemic; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Communities; Contracts; County; Development; Diagnosis; Diagnostic Reagent Kits; Discrimination; Early Diagnosis; Emergency department visit; Environmental Impact; Fright; Geographic Locations; Geography; Goals; Grant; HIV; HIV Infections; HIV diagnosis; HIV risk; High Risk Woman; Home; Hour; Human immunodeficiency virus test; Income; Infection; Intervention; Interview; Lead; Link; Location; Medical; Medical Care Costs; Methods; Minority Women; Modeling; Motivation; Online Systems; Participant; Persons; Phase; Prevention Research; Preventive service; Protocols documentation; Psyche structure; Randomized Controlled Trials; Research; Risk; Risk Factors; Rural; Rural Community; Self Efficacy; Sexually Transmitted Diseases; Structure; Symptoms; Testing; Texas; Transportation; Treatment Cost; Treatment Efficacy; Viral; Woman; antiretroviral therapy; black women; community partnership; cost; digital intervention; economic impact; efficacy testing; ethnic minority; field study; geographic disparity; home test; infection rate; innovation; mortality; pre-exposure prophylaxis; prevent; racial disparity; racial minority; risk perception; rural area; screening; sexual HIV transmission; skills; social; social stigma; suburb; therapy design; therapy development; transmission process; web-based intervention

Project Summary: Racial and geographic disparities in HIV have increased in the US, particularly among Black women. Rural Black women are at greater risk of HIV infection, late-stage diagnosis, and are less likely to sustain viral suppression compared to other racial and ethnic minority women. Black women also have higher rates of sexually transmitted infections (STIs) than other women; many STIs have no symptoms, are undiagnosed, and are untreated. Having an STI triples one’s risk for contracting HIV. Evidence indicates that living in a rural community is a risk factor for lower rates of HIV screening, increased stigma surrounding an HIV diagnosis, later HIV diagnoses, late adoption of antiretroviral therapy, therefore leading to increase HIV- related mortality, highlighting barriers to testing, linkage to care, and linkage to pre-exposure prophylaxis (PrEP). Home HIV/STI testing has promise to increase rates of testing by circumventing barriers and thereby reduce medical costs through early detection and care. Home HIV/STI testing is also a prime opportunity to link Black women at high risk for HIV to PrEP. Yet, home testing alone may not overcome all barriers. Pairing home testing with an intervention designed to increase motivation and overcome barriers has the most promise to increase HIV/STI testing rates. The proposed supplement to the awarded R34 (1R34MH128054-01) aims to focus on Black women living in rural areas and conduct formative research (aim 1) that is imperative for intervention development (aim 2). The intervention draws on 3 components, the situated, information- motivation-behavioral (sIMB) model, mental contrasting, and implementation intentions to develop a new, web- based intervention. This intervention is comprised of 5 sessions: 1) using the HIV/STI home testing kit, 2) mailing in the kit, 3) checking results, 4) obtaining treatment, and 5) attending an appointment for PrEP. Each session is structured the same: information regarding the importance of each behavior, motivation via mental contrasting and methods to overcome the identified barriers, and behavioral skills to increase self-efficacy. The supplement will occur in 2 phases that coincide with the aims to develop and culturally tailor the intervention. 1) Conduct formative research to inform the development of the web-based HIV home testing intervention for Black women at high risk for HIV living in rural areas. We propose to conduct in-depth interviews with 20 Black women living in rural geographic areas in Central Texas to explore the constructs of sIMB, mental contrasting, and implementation intentions to develop the intervention protocol to be field tested in aim 2. 2) develop and tailor the web-based HIV home testing intervention for Black women living in rural geographic areas in Central Texas. We will develop the web-based intervention and field test the intervention among 10 Black women living in rural areas. The web-based design of the intervention greatly increases the opportunity for implementation on a large scale. The long-term goal is to increase HIV/STI testing among Black women in rural areas via scalable and sustainable methods to decrease HIV transmission and subsequent disparities.

项目摘要：艾滋病毒的种族和地理分布在美国有所增加，尤其是在 黑人妇女。农村黑人妇女面临着更大的艾滋病毒感染，后期诊断的风险，并且可能性较小 与其他种族和少数民族妇女相比，维持病毒抑制。黑人妇女也有 与其他女性相比，性传播感染的发生率更高；许多性传播感染没有症状，是 未经诊断，未经治疗。患有感染艾滋病毒的风险有三胞胎。证据表明 生活在农村社区是降低艾滋病毒筛查率的危险因素，围绕艾滋病的污名 HIV诊断，后来的HIV诊断，较晚采用抗逆转录病毒疗法，从而增加了HIV- 相关的死亡率，突出了测试，与护理联系的障碍以及与暴露前预防的联系 （准备）。家庭艾滋病毒/STI测试有望通过规避障碍，从而提高测试速率 通过早期发现和护理降低医疗费用。家庭艾滋病毒/STI测试也是链接的主要机会 黑人妇女患艾滋病毒的风险很高。但是，单独的家庭测试可能无法克服所有障碍。配对 通过旨在增加动力和克服障碍的干预措施进行家庭测试是最有希望的 提高HIV/STI测试率。提议的R34（1R34MH128054-01）的拟议补充旨在 专注于居住在粗糙地区的黑人妇女并进行格式研究（AIM 1），这对于 干预开发（目标2）。干预措施借鉴了3个组件，即位置，信息 - 动机行为（SIMB）模型，心理对比和实施意图，以开发新的网络 基于干预。该干预措施包括5次：1）使用HIV/STI家庭测试套件，2） 在套件中邮寄，3）检查结果，4）获得治疗，5）参加预约准备。每个 会议的结构相同：有关每种行为重要性的信息，通过心理动机 对比和克服确定的障碍以及行为技巧以提高自我高效的方法。这 补充剂将分为两个阶段，与开发和文化量身定制干预措施相吻合。 1） 进行形成性研究，以告知基于Web的HIV家庭测试干预措施的开发 黑人妇女居住在农村地区的艾滋病毒高风险。我们建议对20个黑色进行深入的访谈 居住在得克萨斯州中部粗糙地理区域的妇女探索SIMB的建筑，心理对比， 并实施意图，以制定在目标2中测试的干预协议。2）开发和 针对中央农村地理区域的黑人妇女量身定制基于网络的HIV家庭测试干预措施 德克萨斯州。我们将开发基于网络的干预措施，并测试10名生活的黑人妇女 在粗糙的地区。基于网络的干预设计大大增加了实施的机会 大规模。长期目标是通过 可扩展且可持续的方法，可减少HIV传播和随后的分布。