Integrated online-to-offline (O2O) model of care for HIV prevention and treatment among men who have sex with men

男男性行为者艾滋病预防和治疗的线上线下（O2O）一体化护理模式

• 批准号: 10548402
• 负责人: Roman Shrestha
• 金额: $ 26.09万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548402
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Amphetamines; Attitude; Capital; Caring; Cellular Phone; Clinic; Collaborations; Communication; Communications Media; Communities; Continuity of Patient Care; Counseling; Country; Development; Diagnostic Reagent Kits; Discrimination; Drug usage; Environment; Epidemic; Face; Focus Groups; Fostering; Fright; Guidelines; HIV; HIV/STD; Harm Reduction; Health; Health Personnel; Health Technology; Health care facility; Homosexuality; Hour; Human immunodeficiency virus test; Hybrids; Incidence; Income; Individual; Intervention; Knowledge; Laws; Malaysia; Malaysian; Medical; Mental Depression; Mental disorders; Modeling; Motivation; Muslim population group; Online Systems; Pre-Post Tests; Prevalence; Process; Professional counselor; Psychotropic Drugs; Research; Risk Behaviors; Services; Sexual Partners; Sexual Transmission; Sexuality; Stigmatization; Stimulant; Tablets; Technology; Testing; Time; Unsafe Sex; Wait Time; World Health Organization; acceptability and feasibility; antiretroviral therapy; base; clinical care; cost effective; distrust; eHealth; empowered; experience; high risk; high risk behavior; high risk men; implementation determinants; implementation science; improved; innovation; insight; laptop; marginalized population; men; men who have sex with men; novel strategies; pilot test; pre-exposure prophylaxis; preference; prevention service; prototype; scale up; self testing; service delivery; sex; sexual encounter; social; social stigma; stem; substance use; syndemic; tool; transmission process; treatment as usual; treatment services; usability; willingness

Abstract Malaysia's HIV epidemic is rapidly expanding, with recent evidence suggesting increasing sexual transmission, especially in MSM. HIV prevalence among MSM is now at an all-time high of 21.6% and is concentrated in the country's capital, Kuala Lumpur, where prevalence among MSM is 43% in 2020, up from 22% just four years before. Insights into Malaysia's expanding HIV epidemic are multi-factorial: Both homosexuality and substance use are criminalized in Malaysia. MSM are, therefore, often hesitant to disclose their sexuality or risk behaviors, primarily due to fear of stigma, discrimination, or criminalization. Further, evidence suggests the widespread use (24%) of psychoactive substances (e.g., amphetamine-type stimulants) before or during a sexual encounter, also known as sexualized drug use (chemsex) among Malaysian MSM, which leads to high-risk sexual practices (e.g., condomless sex). Stigma and discrimination are also enacted on MSM by healthcare providers, which foster a hostile environment toward MSM, complicating efforts to scale-up of HIV testing and subsequent linkage to HIV prevention (pre-exposure prophylaxis) and treatment (antiretroviral therapy) services. HIV testing jumpstarts entry into the HIV prevention and treatment cascades. New HIV testing guidelines recommend MSM test every 3 to 6 months, as early HIV testing is a cost-effective strategy for stemming the HIV epidemic. Yet, HIV testing rates remain low among Malaysian MSM: ever tested (70.3%) and last year tested (30.9%). HIV self- testing (HIVST) may be particularly impactful among MSM in Malaysia. Although willingness to use HIVST is high in this group, its use is still minimal due to lack of access to HIVST kits, concerns related to misinterpreting results, and missed opportunities for counseling and linkage to care. In this context, eHealth represents an innovative platform to transform the face of HIV service delivery (i.e., testing and linkage to care). Leveraging eHealth platforms for HIV services delivery in Malaysia is ideal given that nearly all (>99%) MSM use some form of communication technology (e.g., smartphone, laptop) and has a strong preference for web-based platforms for HIVST. Therefore, we developed and pilot-tested a web-based HIVST platform, called Jom-Test®, to promote HIV testing by providing free anonymous HIVST. The results demonstrated high feasibility and acceptability for the platform but low post-test linkage to treatment and prevention services. The findings further indicated the need for real-time (online) access to counselors for pre- and post-test counseling and support for linkage to HIV and chemsex-related harm reduction services (offline). To address this evidence gap, we propose to jump-start the broader HIV care continuum by adapting, expanding, and refining an existing Jom-Test® platform. The enhanced version, to be called Jom-TestPlus, will include real-time e-counseling (eHIVST) with integrated O2O linkage to HIV prevention and treatment services while simultaneously co-addressing chemsex-related needs for Malaysian MSM. This model represents a potentially impactful strategy for reaching marginalized populations, like MSM, and allows immediate engagement in the post-test linkage process to prevention or treatment services.

抽象的 马来西亚的艾滋病毒流行正在迅速扩大，最近的证据表明，性传播增加， 特别是在MSM中。 MSM中的HIV患病率现在为21.6％，集中在 国家首都吉隆坡，在2020年，MSM的患病率为43％，高于22％仅四年 前。对马来西亚不断扩大的艾滋病毒流行的见解是多因素的：同性恋和基板 使用在马来西亚被定为刑事犯罪。因此，MSM通常不愿透露其性行为或风险行为， 首先是由于担心污名，歧视或犯罪。此外，有证据表明宽度 在性接触之前或期间，使用（24％）的精神活性物质（例如苯丙胺型兴奋剂） 在马来西亚MSM中也称为性吸毒（ChemSex），这导致了高风险的性行为 （例如，无避孕套性）。医疗保健提供者还对MSM颁布了污名和歧视，这促进了 一个敌对的MSM环境，使艾滋病毒测试的扩展以及随后的联系变得复杂 HIV预防（预防前预防）和治疗（抗逆转录病毒疗法）服务。艾滋病毒测试 跳动进入艾滋病毒预防和治疗级联。新的HIV测试指南建议MSM 每3到6个月测试一次，因为早期的HIV测试是阻止HIV流行的成本效益策略。然而， 在马来西亚MSM中，HIV测试率仍然很低：经过测试（70.3％），去年测试（30.9％）。艾滋病自我 在马来西亚的MSM中，测试（HIVST）可能特别影响。虽然愿意使用HIVST是 在该组中，由于缺乏获得HIVST套件的访问，其使用仍然很少 结果，错过了咨询和联系的机会。在这种情况下，eHealth代表 创新平台改变了艾滋病毒服务提供的面貌（即测试和关联链接）。利用 鉴于几乎所有（> 99％）MSM使用某种表格 通信技术（例如，智能手机，笔记本电脑），对基于Web的平台有强烈的偏爱 对于HIVST。因此，我们开发了一个基于网络的HIVST平台，称为Jom-Test®，以促进 通过提供免费的匿名HIVST来进行HIV测试。结果表明对 该平台但测试后与治疗和预防服务的联系低。调查结果进一步表明 需要实时（在线）访问计数，以进行测试前和测试后的共同组件，并支持与艾滋病毒的联系 和与ChemSe相关的减少危害服务（离线）。为了解决这一证据差距，我们建议开始启动 通过适应，扩展和完善现有的JOM-TEST®平台，更广泛的艾滋病毒护理连续体。这 增强版本，称为JOM-TESTPLUS，将包括带有集成O2O的实时电子表面（EHIVST） 与艾滋病毒预防和治疗服务的联系，同时共同补充了与ChemSex相关的需求 马来西亚MSM。该模型代表了达到边缘化人群的潜在影响策略， 像MSM一样，并允许立即参与预防或治疗服务的测试后链接过程。