An Intervention to Increase Retention in Care among HIV-Positive Black Men

提高艾滋病毒阳性黑人男性护理保留率的干预措施

• 批准号: 9978617
• 负责人: Wilson Vincent
• 金额: $ 0.01万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2021-10-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978617
• 关键词: AIDS/HIV problem; Accident and Emergency department; Address; Adherence; Administrator; Affect; Age; Alcohol or Other Drugs use; Applications Grants; Appointment; Awareness; Back; Behavior; Caring; Case Management; Cities; Clinic; Clinical; Communities; Continuity of Patient Care; County; Data; Detection; Diagnosis; Drops; Education; Effectiveness; Emotions; Enrollment; Evaluation; Funding; Goals; Gold; HIV; HIV Infections; HIV Seropositivity; Health; Health Services Accessibility; Healthcare; Hour; Incidence; Income; Intervention; Interview; Knowledge; Left; Life; Link; Literature; Mental Depression; Mentors; Mentorship; Monitor; Morbidity - disease rate; Outcome; Participant; Patients; Persons; Phase; Pilot Projects; Population; Preparation; Prevalence; Prevention; Process; Protocols documentation; Psychosocial Factor; Qualitative Methods; Qualitative Research; Recommendation; Research; Research Activity; Research Design; Research Methodology; Research Personnel; Risk; Safety; Sampling; Site; Social support; Structure; Study Subject; Techniques; Testing; Text Messaging; Thinking; Training; Travel; United States National Institutes of Health; Viral; Vulnerable Populations; Work; acute symptom; antiretroviral therapy; barrier to care; base; behavior change; black men who have sex with men; career development; community setting; data format; efficacy trial; experience; flexibility; follow-up; literacy; mHealth; member; men; men who have sex with men; mobile application; mortality; portability; post intervention; psychosocial; racism; recruit; research and development; satisfaction; skills; social group; social stigma; theories; therapy development; trial design

PROJECT SUMMARY/ABSTRACT In the U.S., Black men who have sex with men (BMSM) have a higher incidence and background prevalence of HIV than other groups. Once linked to HIV care, HIV+ BMSM (+BMSM) have significantly lower odds than other MSM to be engaged in each step of the HIV continuum of care: detection of HIV, linkage to care, retention in care, adherence to antiretroviral therapy (ART), and viral suppression. The biggest drop off in the continuum for +BMSM is in retention in care, in which over 40% drop out of care, and, thus, is the focus of this research. Despite the importance of this issue, there are no gold-standard interventions to find these men once they have fallen out of care. Further, although interventions exist that focus primarily on structural barriers to care (e.g., intensive case management, patient navigation), key psychosocial factors involved in +BMSM dropping out of care (e.g., depression, substance use, HIV-related stigma, lack of social support) have not been sufficiently addressed. In addition, there is a dearth literature on how best to locate +BMSM who have left HIV care (+BMSM-LC) in order to re-engage them in care. Thus, the overarching goal of this application is to develop and conduct a preliminary test of a “portable” intervention, “Black Men's Care” (BMC), to re-engage +BMSM-LC in care that is flexible with respect to where it can be conducted. The aims of the study are: Aim 1—to conduct formative research to develop BMC content and optimize its delivery; Aim 2—to develop BMC, a theory-based, combination in-person and text messaging (mHealth) intervention for +BMSM-LC; and Aim 3— to evaluate the acceptability, feasibility, and preliminary outcomes of BMC in preparation for submitting an R01 proposal to finalize and conduct an efficacy trial of BMC. Aims 1 and 2 will comprise the formative phase of the proposed study. Aim 1 will consist of semi-structured interviews with 2 staff members at each of 3 city and county health clinics, 3 community-based organizations, and 3 emergency rooms to identify effective settings for intervention. Aim 2 will consist of semi-structured interviews with 10 +BMSM-LC and 10 +BMSM who remain in care to develop intervention content. Findings from these semi-structured interviews and Aim 1 will be used to develop a preliminary intervention protocol that will be refined across 2 sets of 3 sequential, single- subject iterations of the intervention sampled by age (n=3 for ages 18 to 29 years, n =3 for ages 30 and up). For Aim 3, a pilot study of 18 +BMSM-LC purposively sampled by age will assess acceptability, feasibility, and preliminary outcomes of BMC for re-engaging +BMSM-LC in care. The research and career development activities of this K23 proposal will allow the PI to achieve the goal of becoming an independent, R01-funded investigator. The PI will gain a broad range of critical skills (e.g., intervention development; qualitative research methods; trial design, safety monitoring, and process and outcome evaluation) and experiences to address the health needs of vulnerable populations at greatest risk of morbidity and mortality.

项目概要/摘要 在美国，男男性行为黑人 (BMSM) 的发病率和背景患病率较高 一旦与 HIV 护理联系起来，HIV+ BMSM (+BMSM) 的感染率明显低于其他群体。 其他 MSM 参与艾滋病毒连续护理的每一步：艾滋病毒检测、与护理的联系、 护理保留率、抗逆转录病毒治疗（ART）依从性和病毒抑制率下降幅度最大。 +BMSM 的连续体是保留护理，其中超过 40% 的人退出护理，因此，这是本次研究的重点 尽管这个问题很重要，但目前还没有金标准的干预措施可以找到这些人。 此外，尽管存在主要针对结构性障碍的干预措施，但他们已经不再受到照顾。 护理（例如，重症病例管理、患者导航）、+BMSM 涉及的关键社会心理因素 脱离护理（例如抑郁、药物滥用、与艾滋病毒相关的耻辱、缺乏社会支持）并没有 此外，关于如何最好地找到离开的+BMSM 的文献也很少。 HIV 护理 (+BMSM-LC) 以便让他们重新参与护理 因此，该应用程序的首要目标是 制定并进行“便携式”干预措施“黑人男性护理”(BMC) 的初步测试，以重新参与 +BMSM-LC 的护理在其实施地点方面是灵活的 该研究的目的是： 目标。 1 — 进行形成性研究以开发 BMC 内容并优化其交付； 目标 2 — 开发 BMC， +BMSM-LC 和目标 3 的基于理论的面对面和短信（移动医疗）干预； 评估 BMC 的可接受性、可行性和初步结果，为提交 R01 做准备 最终确定并进行 BMC 目标 1 和 2 有效性试验的提案将构成 BMC 的形成阶段。 拟议的研究目标 1 将包括对 3 个城市和 2 个城市的 2 名工作人员进行半结构化访谈。 县卫生诊所、3 个社区组织和 3 个急诊室，以确定有效的设置 目标 2 将包括对 10 +BMSM-LC 和 10 +BMSM 进行半结构化访谈。 继续关注这些半结构化访谈和目标 1 的调查结果。 用于制定初步干预方案，该方案将在 2 组 3 个连续、单次治疗中进行完善 按年龄抽样的干预措施的受试者迭代（18 至 29 岁 n = 3，30 岁及以上 n = 3）。 对于目标 3，一项针对 18 +BMSM-LC 有目的地按年龄抽样的试点研究将评估可接受性、可行性和 BMC 重新参与+BMSM-LC 护理研究和职业发展的初步成果。 该 K23 提案的活动将使 PI 实现成为独立的、由 R01 资助的组织的目标 PI 将获得广泛的关键技能（例如干预开发；定性研究）。 方法；试验设计、安全监测以及过程和结果评估）和解决问题的经验 发病和死亡风险最大的弱势群体的健康需求。