Increasing HIV/STI Home Testing, Linkage toCare, and Linkage to PrEP via a Digital Intervention among Black Women in a GeographicHotspot

通过对地理热点地区黑人妇女进行数字干预，增加艾滋病毒/性传播感染的家庭检测、与护理的联系以及与 PrEP 的联系

• 批准号: 10836231
• 负责人: Liesl A Nydegger
• 金额: $ 24.56万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-05 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10836231
• 关键词: Accounting; Adoption; Appointment; Behavior; Behavioral; Behavioral Model; COVID-19 pandemic; Caring; Child Care; Clinic; Communities; Contracts; County; Diagnosis; Diagnostic Reagent Kits; Discrimination; Disparity; Disparity in diagnosis; Early Diagnosis; Education; Emergency department visit; Environmental Impact; Epidemic; Ethnic Origin; Evaluation; Failure; Focus Groups; Fright; Future; Geography; Goals; HIV; HIV Seropositivity; HIV diagnosis; HIV disparities; HIV risk; High Risk Woman; Home; Hour; Human immunodeficiency virus test; Income; Infection; Intervention; Lead; Learning; Link; Location; Low income; Medical; Medical Care Costs; Methods; Modeling; Motivation; Online Systems; Outcome; Participant; Persons; Phase; Population; Preventive service; Protocols documentation; Psyche structure; Race; Randomized; Research; Risk; Self Efficacy; Sexually Transmitted Diseases; Structure; Symptoms; Testing; Texas; Transportation; Treatment Cost; Underserved Population; Woman; acceptability and feasibility; austin; barrier to testing; black women; community partnership; cost; digital intervention; economic impact; efficacy trial; field study; follow up assessment; follow-up; high risk; home test; infection rate; innovation; pre-exposure prophylaxis; prevent; racial disparity; risk perception; screening; sexual HIV transmission; skills; social; social stigma; therapy design; transmission process; trend; virtual; web-based assessment; web-based intervention

PROJECT SUMMARY: In Travis County, Texas, deemed a HIV geographic hotspot due to high HIV rates, Black women are 18.4 times more likely to contract HIV compared to women of other races/ethnicities. Black women also have higher rates of sexually transmitted infections (STIs) than other women; many STIs have no symptoms, are undiagnosed, and are untreated. Having an STI triples one's risk for contracting HIV. In Travis County, over 20% of women learned one year after contracting HIV that they were HIV-positive, highlighting barriers to testing. Home HIV/STI testing has promise to increase rates of testing by circumventing barriers and thereby reduce medical costs through early detection and care. Home HIV/STI testing is also a prime opportunity to link Black women at high risk for HIV to pre-exposure prophylaxis (PrEP). Yet, home testing alone may not overcome all barriers. Pairing home testing with an intervention designed to increase motivation and overcome barriers has the most promise to increase HIV/STI testing rates. The proposed project draws on 3 components, the situated, information-motivation-behavioral (sIMB) model, mental contrasting, and implementation intentions to develop a new, web-based intervention. This intervention is comprised of 5 sessions: 1) using the HIV/STI home testing kit, 2) mailing in the kit, 3) checking results, 4) obtaining treatment, and 5) attending an appointment for PrEP. Each session is structured the same: information regarding the importance of each behavior (i.e., taking the home test, mailing in the test, checking results, linkage to care, and linkage to PrEP), motivation via mental contrasting (identifying positive outcomes and barriers to each session) and methods to overcome the identified barriers (implementation intentions), and behavioral skills to increase self-efficacy. The project will occur in 3 phases that coincide with the aims to develop and culturally tailor the intervention. 1) Conduct formative research to develop the intervention. Four focus groups (n=4-6), with 24 Black women from Travis County will explore the constructs of sIMB, mental contrasting, and implementation intentions to develop the intervention protocol to be field tested in Aim 2. 2) Field test the intervention. We will test the preliminary feasibility and acceptability of the intervention with 6 participants to make any necessary adjustments for Aim 3. 3) Conduct a feasibility pilot of the intervention. We will determine the feasibility, acceptability, and preliminary efficacy among 60 Black women in Travis County. Participants will be randomly assigned to the intervention or a web-based educational control. We hypothesize that the intervention will be feasible, acceptable, and demonstrate a trend toward efficacy for completion of home testing, linkage to care, and linkage to PrEP. Follow-up web-based assessments will be administered 2-, 4-, and 6-months after baseline. The web-based design of the intervention greatly increases the opportunity for implementation on a large scale. The long-term goal is to increase HIV/STI testing among low-income Black women via scalable and sustainable methods to decrease HIV transmission and subsequent disparities.

项目摘要：德克萨斯州特拉维斯县因艾滋病毒感染率高而被视为艾滋病毒地理热点地区， 与其他种族/民族的女性相比，黑人女性感染艾滋病毒的可能性高出 18.4 倍。黑色的 女性的性传播感染率（STI）也高于其他女性；许多性传播感染没有 症状，未确诊，也未治疗。患有性传播感染会使感染艾滋病毒的风险增加三倍。在特拉维斯 该县超过 20% 的女性在感染艾滋病毒一年后得知她们的艾滋病毒呈阳性，这凸显了 测试的障碍。家庭艾滋病毒/性传播感染检测有望通过规避障碍和提高检测率 从而通过早期发现和护理来降低医疗费用。家庭 HIV/STI 检测也是一个主要方法 将艾滋病毒高危黑人女性与暴露前预防 (PrEP) 联系起来的机会。然而，家庭测试 仅凭一己之力可能无法克服所有障碍。将家庭测试与旨在提高动力的干预措施结合起来 并克服障碍最有希望提高艾滋病毒/性传播感染检测率。拟议的项目借鉴了 3 个组成部分，情境信息动机行为 (SIMB) 模型、心理对比和 实施意图开发一种新的、基于网络的干预措施。该干预措施包括 5 课程：1) 使用 HIV/STI 家庭检测套件，2) 邮寄套件，3) 检查结果，4) 获得治疗， 5) 参加 PrEP 预约。每个会话的结构都相同：有关以下内容的信息 每个行为的重要性（即参加家庭测试、邮寄测试、检查结果、与护理的联系、 以及与 PrEP 的联系），通过心理对比进行激励（确定积极的结果和每个方面的障碍） 会议）和克服已识别障碍的方法（实施意图），以及行为技能 提高自我效能。该项目将分三个阶段进行，与发展和文化的目标相一致 调整干预措施。 1) 进行形成性研究以制定干预措施。四个焦点小组（n=4-6）， 与来自特拉维斯县的 24 名黑人女性将探讨 SIMB、心理对比和 制定干预协议的实施意图，以在目标 2 中进行现场测试。 2) 现场测试 干涉。我们将与 6 名参与者一起测试干预措施的初步可行性和可接受性 对目标 3 进行必要的调整。 3) 进行干预措施的可行性试点。我们将确定 特拉维斯县 60 名黑人妇女的可行性、可接受性和初步效果。参与者将 被随机分配到干预或基于网络的教育控制。我们假设 干预措施将是可行的、可接受的，并且显示出完成家庭治疗的有效性的趋势 测试、与护理的联系以及与 PrEP 的联系。后续基于网络的评估将在 2、4、 以及基线后 6 个月。基于网络的干预设计大大增加了 大规模实施。长期目标是增加低收入黑人的艾滋病毒/性传播感染检测 妇女通过可扩展和可持续的方法来减少艾滋病毒传播和随后的差异。