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 感染率目前达到 21.6% 的历史最高水平，并且集中在 该国首都吉隆坡的 MSM 患病率在四年内为 22%，而到 2020 年将达到 43% 之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：同性恋和物质。 因此，MSM 在马来西亚将性行为定为刑事犯罪，因此常常不愿透露自己的性取向或危险行为， 此外，有证据表明，这主要是由于担心耻辱、歧视或定罪。 在性接触之前或期间使用（24％）精神活性物质（例如安非他明类兴奋剂）， 在马来西亚男男性接触者中也被称为性药物使用（chemsex），这会导致高风险的性行为 （例如，无套性行为）。医疗保健提供者也对男男性行为者进行污名化和歧视，从而助长了男男性行为者的行为。 对 MSM 充满敌意的环境，使扩大艾滋病毒检测和随后与艾滋病毒相关联的努力变得复杂化 HIV 预防（暴露前预防）和治疗（抗逆转录病毒治疗）服务。 新的艾滋病毒检测指南建议 MSM 进入艾滋病毒预防和治疗阶段。 每 3 至 6 个月进行一次检测，因为早期 HIV 检测是遏制 HIV 流行的经济有效的策略。 马来西亚男男性行为者的艾滋病毒检测率仍然很低：曾经检测过（70.3％）和去年进行过艾滋病毒自我检测（30.9％）。 尽管使用 HIVST 的意愿较低，但检测 (HIVST) 对马来西亚的 MSM 可能特别有影响。 在这一群体中的比例较高，但由于缺乏艾滋病毒检测工具包以及与误解相关的担忧，其使用仍然很少 在这种情况下，电子医疗代表了一种结果，并错过了咨询和联系的机会。 改变艾滋病毒服务提供方式的创新平台（即检测和与护理的联系）。 马来西亚用于提供艾滋病毒服务的电子医疗平台非常理想，几乎所有 (>99%) MSM 都使用某种形式 对通信技术（例如智能手机、笔记本电脑）有浓厚的兴趣，并且对基于网络的平台有强烈的偏好 因此，我们开发并试点了一个名为 Jom-Test® 的基于网络的 HIVST 平台，以促进推广。 通过提供免费匿名 HIVST 进行 HIV 检测，结果证明了其高度的可行性和可接受性。 平台，但测试后与治疗和预防服务的联系较低。调查结果进一步表明 需要实时（在线）联系咨询师进行测试前和测试后咨询以及与艾滋病毒联系的支持 为了解决这一证据差距，我们建议启动与 chemsex 相关的减害服务。 通过调整、扩展和完善现有的 Jom-Test® 平台，实现更广泛的艾滋病毒护理连续体。 增强版称为 Jom-TestPlus，将包括具有集成 O2O 的实时电子咨询 (eHIVST) 与艾滋病毒预防和治疗服务联系起来，同时共同解决与化学性相关的需求 马来西亚 MSM。该模式代表了一种覆盖边缘化人群的潜在有效策略， 与 MSM 类似，并允许立即参与测试后与预防或治疗服务的联系过程。