Mobilizing Social Network Resources for HIV Care Support: Development and Testing of an Intervention for HIV-Positive MSM in St. Petersburg, Russia

动员社交网络资源支持艾滋病毒护理：俄罗斯圣彼得堡艾滋病毒阳性男男性接触者干预措施的开发和测试

• 批准号: 10304207
• 负责人: Yuri A Amirkhanian
• 金额: $ 19.59万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-11-17 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10304207
• 关键词: Acquired Immunodeficiency Syndrome; Adherence; Advocacy; Affect; Age; Alcohol abuse; Appointment; Caregivers; Caring; Characteristics; Communities; Counseling; Country; Development; Epidemic; Ethics; Face; Family member; Feedback; Feeling; Friends; HIV; HIV Infections; HIV Seropositivity; Health; Health Benefit; Individual; Infection; Injections; Intervention; Intervention Studies; Interview; Lesbian Gay Bisexual Transgender; Life; Link; Mediating; Medical; Outcome; Participant; Persons; Pharmaceutical Preparations; Phase; Preparation; Prevalence; Procedures; Public Health; Qualitative Research; Randomized; Recommendation; Reporting; Research; Research Methodology; Resources; Risk Behaviors; Russia; Same-sex; Services; Sex Orientation; Sexual Transmission; Social Development; Social Network; Social support; Speed; Stigmatization; Supportive care; Testing; Treatment Efficacy; Viral; Viral Load result; Visit; Work; antiretroviral therapy; base; community setting; comparison group; coping; data format; disease transmission; effectiveness evaluation; experience; follow-up; group intervention; implementation evaluation; implementation intervention; improved; injection drug use; member; men who have sex with men; pilot test; post intervention; prevent; primary outcome; psychosocial; psychosocial adjustment; psychosocial wellbeing; recruit; referral services; resilience; same sex behavior; secondary outcome; self esteem; social; social exclusion; social group; social stigma; sociodemographics; substance use; therapy design; therapy development; treatment adherence; treatment as prevention; uptake

ABSTRACT Russia is one of five countries that account for the greatest number of infections in the world. Although historically associated with drug injection, Russia’s HIV epidemic is now primarily sexual, with a large number of infections among MSM. With few supports for medical care engagement, most HIV-positive MSM in Russia have unsuppressed viral load, fueling high continued disease transmission and poor health outcomes. HIV care engagement, adherence, and psychosocial coping are better among persons with supportive social resources. Given the hostile social circumstances they face, improved social supports are critical for the medical care engagement and psychosocial adjustment of HIV-positive MSM in Russia. This study will test an approach to help out-of-care, HIV-positive MSM identify, access, and mobilize social resources to support HIV care engagement. The mixed-methods research will begin with a formative phase of in-depth interviews with 25 PLH MSM in St. Petersburg as well as one supportive resource network member in the life of each participant to characterize the kinds of social resources that can be harnessed to support HIV care. Formative data and input from the study’s Community Advisory Panel will inform the tailoring of an intervention that has already been successfully pilot tested. The intervention study will recruit 100 out-of-care HIV+ MSM in community settings and online. After completing baseline assessments, participants will be randomized to either an individual care counseling (ICC) comparison condition or ICC plus a social support mobilization (SSM) intervention. In it, PLH MSM will attend five main and two booster sessions that underscore the benefits of medical care engagement, counter the effects of internalized intersectional stigma and promote resilience, and help participants develop and mobilize social resources supportive of HIV care. Support mobilization will begin by assisting participants develop care-supportive bonds with other group members, PLH friends, and connections made with LGBT and PLH NGOs. They will also be guided in developing and expanding supportive links with affirmative friends, family members, and other resources. In this way, the intervention will bolster care-related social support resources, resilience, and feelings of self-worth. Assessments administered at baseline will be repeated 6 and 12 months post-intervention, and in-depth followup interviews will be conducted with a subset of 20 participants to elicit feedback about the intervention experience. We hypothesize that the SSM intervention will produce greater preliminary evidence of benefit on the primary outcome of medical care attendance in the past 6 months and on secondary outcomes of having undetectable viral load, ART adherence, and psychosocial well-being. We will explore whether care-related outcomes are mediated by increases in social resources and other factors. If there is evidence of benefit, the intervention will be offered to the former comparison group as an ethical service after the final followup. If project findings are successful, we will plan a later evaluated full-scale implementation of the intervention.

抽象的 俄罗斯是世界上感染人数最多的五个国家之一。 历史上，俄罗斯的艾滋病毒流行与注射吸毒有关，但现在主要是性传播，大量感染者 由于对医疗保健参与的支持很少，俄罗斯大多数艾滋病毒呈阳性的男男性行为者的感染率。 病毒载量不受抑制，加剧了疾病的持续传播和艾滋病毒的不良健康结果。 拥有社会支持的人的护理参与度、依从性和社会心理应对能力更好 鉴于他们面临的敌对社会环境，改善社会支持对于他们至关重要。 俄罗斯艾滋病毒阳性男男性接触者的医疗保健参与和心理社会调整本研究将测试一项。 帮助失去护理的艾滋病毒阳性男男性接触者识别、获取和动员社会资源来支持艾滋病毒的方法 混合方法研究将从深入访谈的形成阶段开始。 圣彼得堡的 25 位 PLH MSM 以及每个人生活中的一名支持性资源网络成员 参与者描述可用于支持艾滋病毒护理的社会资源类型。 该研究的社区咨询小组的数据和输入将为干预措施的调整提供信息 该干预研究已成功进行试点测试，将招募 100 名非护理 HIV+ MSM。 社区设置和在线完成基线评估后，参与者将被随机分配到 个人护理咨询 (ICC) 比较条件或 ICC 加上社会支持动员 (SSM) 干预中，PLH MSM 将参加五次主要会议和两次加强会议，强调其好处。 医疗保健参与度，对抗内部交叉耻辱的影响并提高复原力， 帮助参与者开发和动员支持艾滋病毒护理的社会资源。 首先帮助参与者与其他小组成员、PLH 朋友和患者建立护理支持联系 他们还将指导他们发展和扩大与 LGBT 和 PLH 非政府组织的联系。 通过这种方式，干预将与积极的朋友、家人和其他资源建立支持性联系。 增强与护理相关的社会支持资源、复原力和自我价值感。 干预后 6 个月和 12 个月将重复基线调查，并将进行深入的后续访谈 我们对 20 名参与者进行了调查，以征求有关干预体验的反馈。 此外，SSM 干预措施将产生更多初步证据，证明对主要患者有益。 过去 6 个月内就医的结果以及未检测到的次要结果 我们将探讨与护理相关的结果是否与病毒载量、ART 依从性和社会心理健康有关。 通过社会资源和其他因素的增加来调节。如果有证据表明干预是有益的，那么干预就会起作用。 如果项目结果是最终跟进后，将作为道德服务提供给前一个对照组。 如果成功，我们将计划稍后评估全面实施干预措施。