Implementation of a Sexual Health Intervention for YMSM in Two Vietnamese Cities

在越南两个城市实施 YMSM 性健康干预措施

基本信息

批准号：
8310667
负责人：
Michael C. Clatts
金额：
$ 67.92万
依托单位：
NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-06-01 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8310667
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Africa South of the Sahara Age Alcohol abuse Asia Awareness Behavioral Cambodia Caring Cessation of life China Cities Clinic Collaborations Communities Community Health Services Community Outreach Complex Country Cross-Sectional Studies Data Dependency Development Discipline of Nursing Discrimination Early Diagnosis Economics Education Effectiveness Enrollment Epidemic Epidemiologic Studies Epidemiology Ethnography Evaluation Exposure to Face Female Fostering Funding Future Gays Goals HBV Vaccination HIV HIV/STD Harm Reduction Health Promotion Health Services Healthcare Hepatitis B Virus Hepatitis C virus High Prevalence Human Papillomavirus Human immunodeficiency virus test Incidence Income India Individual Indonesia Infection International Intervention Knowledge Life Mental Depression Mental Health Methods Modeling Myanmar National Institute of Drug Abuse Nurses Outcome Outcome and Process Assessment Participant Pattern Pharmaceutical Preparations Policies Population Population Sizes Prevention Prevention program Process Protocols documentation Recording of previous events Research Research Design Research Infrastructure Risk Risk Reduction Route Screening procedure Self Perception Services Sexual Health Singapore South Korea Southeastern Asia Stigmata Symptoms Technology Testing Thailand Time Unsafe Sex Vaccination Vietnam Work Youth base disorder control experience high risk holistic approach implementation science improved interest male male sex worker men who have sex with men metropolitan neglect outreach peer prevention service programs response risk perception service intervention sex skills social social stigma surveillance data systematic review therapy development transmission process uptake

项目摘要

DESCRIPTION (provided by applicant): Both surveillance and behavioral epidemiological studies show that young male sex workers (YMSWs) in Vietnam have high rates of unprotected sex with multiple, concurrent partners - including both male and female partners - contributing to high rates of STIs and HIV and amplifying already high HIV incidence. Exposure to existing prevention programming is low, with major gaps in HIV knowledge and sexual risk reduction skills. Existing community outreach activities have primarily reached gay-identified YMSM. Moreover, owing to profound risk for stigma and discrimination in health care settings, few YMSW are engaged and retained in protective health services (including STI/HIV screening, HBV/HPV vaccination, and early linkages to HIV care). Our collaborative US/Vietnam research team has been conducting NIDA-funded HIV research among high risk youth populations, including YMSWs, for the past eight years. Building on the substantial research capacity and health services infrastructure that has been achieved in our prior work, we propose to address these gaps in community outreach and health services access by implementing a composite intervention package targeted to YMSWs in the two strategically selected cities in Vietnam (Hanoi and Ho Chi Minh City). Using Sexual Health Promotion as a conceptual framework, we will combine already proven intervention technologies - community outreach nursing and sexual health promotion interventions - to enhance outreach coverage and to foster engagement and retention in health services. Significant levels of outreach coverage will be achieved (with an estimated 12,000 outreach contacts) and substantial numbers of health services will be delivered (2,400 health services participants). Using a mixed-methods approach that includes anthropological ethnography, social and behavioral epidemiology, and health services assessments, process and outcomes evaluation of both the community outreach and health services intervention will be undertaken. Repeated cross-sectional surveys, administered both prior to and following implementation of the community outreach and health services intervention, will document community-level increases in exposure to outreach, increased knowledge and awareness of behavioral HIV risk, increased sexual risk reduction skills and participation in the clinic-based sexual health promotion intervention, thus demonstrating effective engagement and retention in health services. Of particular interest to implementation science, both qualitative and quantitative analysis will assess between-city differences in intervention uptake and effectiveness, data that will inform our understanding of the impact, adaptability, and generalizability of the intervention and guide future dissemination. PUBLIC HEALTH RELEVANCE: Young male sex workers in Vietnam show high prevalence rates of HIV and other STIs, reflecting their involvement in multiple concurrent sex exchanges with both male and female partners, yet they have limited exposure to, or engagement in, health services, including community outreach, HIV/STI testing and treatment, and vaccination for HBV and HPV. Building on the substantial research capacity and health services infrastructure developed in our prior research collaboration in Vietnam, we propose to address these gaps in community outreach and health services access by using Sexual Health Promotion as a conceptual framework, and a research design based on principles of implementation science to deliver an intervention that combines already proven intervention technologies - community outreach nursing and sexual health promotion interventions - to enhance outreach coverage and to foster engagement and retention in health services among YMSWs in the two strategically selected cities in Vietnam (Hanoi and Ho Chi Minh City). It is anticipated that the intervention will significantly contribute to intervention capacity-building in Vietnam and may als contribute to intervention development in neighboring countries in Southeast Asia that face similar challenges.

描述（由申请人提供）：监视和行为流行病学研究都表明，越南的年轻男性性工作者（YMSW）具有很高的未受保护性别的性别，包括多个并发伴侣（包括男性和女性伴侣），包括高性病和HIV率很高，并增加了已经很高的Hiv Hiv Hivifies。接触现有的预防节目较低，艾滋病毒知识和降低性风险技巧的主要差距。现有的社区外展活动主要达到了同性恋识别的YMSM。此外，由于在医疗保健环境中污名和歧视的巨大风险，因此很少有YMSW参与保护和保留在保护性卫生服务中（包括STI/HIV筛查，HBV/HPV疫苗接种以及与HIV护理的早期联系）。在过去的八年中，我们的美国/越南研究团队一直在包括YMSW在内的高风险青年人群中进行NIDA资助的HIV研究。在我们先前工作中实现的实质性研究能力和卫生服务基础设施的基础上，我们建议通过实施针对越南两家战略性选择的城市（Hanoi and Ho Chi Minh City）的YMSWS的综合干预套件来解决社区外展和卫生服务访问中的这些差距。使用性健康促进作为概念框架，我们将结合已验证的干预技术 - 社区外展护理和性健康促进干预措施 - 以增强外展覆盖范围，并促进卫生服务的参与和保留。将实现大量水平的外展承保范围（估计有12,000个外展联系），并将提供大量的卫生服务（2,400名卫生服务参与者）。使用包括人类民族志，社会和行为流行病学以及健康服务评估，过程和结果评估的混合方法方法，将进行社区外展和卫生服务干预的评估。在实施社区外展和卫生服务干预之前和之后进行的重复横断面调查，将记录社区级别的外展暴露量，提高知识和对行为HIV风险的知识和认识的认识，增加性风险降低技能和参与临床健康健康促进措施，从而表现出有效的参与和保留卫生服务。实施科学特别感兴趣的是，定性和定量分析都将评估干预吸收和有效性的城市间差异，这些数据将使我们对干预的影响，适应性和普遍性的理解，并指导未来的传播。公共卫生相关性：越南的年轻男性性工作者表现出较高的艾滋病毒和其他性传播感染感染率，这反映了他们与男性和女性伴侣的多次并发性交的参与，但他们对卫生服务的影响有限，包括社区外展，HIV/STI测试，治疗以及HBV和HPV疫苗。在我们先前在越南的研究合作中开发的大量研究能力和健康服务基础设施的基础上，我们建议通过使用性健康促进作为概念框架来解决社区外展和卫生服务访问中的这些差距在越南两个战略性选择的城市（河内和胡志明市）的YMSW中。可以预计，干预措施将极大地促进越南的干预能力建设，May ALS为面临类似挑战的东南亚邻国的干预发展做出了贡献。