Integrating Mental Health into HIV Prevention and Care Continua Services and Systems for Young GBMSM in Kenya: A Community-Led Participatory Approach

将心理健康纳入肯尼亚青年 GBMSM 的艾滋病毒预防和护理持续服务和系统：社区主导的参与方法

• 批准号: 10574532
• 负责人: GARY W HARPER
• 金额: $ 21.53万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-16 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10574532
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Africa South of the Sahara; African; Alcohol abuse; Applications Grants; Attitude; Bisexual; Caring; Case Manager; Clinic; Communities; Coupled; Data; Data Analyses; Development; Disadvantaged; Discrimination; Feedback; Focus Groups; Gays; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; Health Personnel; Health Promotion; Human immunodeficiency virus test; Individual; Infection; Infrastructure; Intervention; Interview; Kenya; Lead; Lesbian Gay Bisexual Transgender Queer; Light; Mental Health; Mental health promotion; Methods; Modeling; Outcome; Patients; Persons; Population; Prevalence; Recommendation; Reporting; Research; Research Personnel; Risk; Risk Behaviors; Sanitation; Services; Social support; Stretching; Suggestion; System; Testing; Treatment outcome; United States National Institutes of Health; Violence; Work; Writing; care systems; community based participatory research; coping; coronavirus disease; depressive symptoms; experience; improved; integrated care; member; men; men who have sex with men; mental health organization; multidisciplinary; post-traumatic symptoms; pre-exposure prophylaxis; prevention service; programs; psychosocial; same sex behavior; service delivery; service providers; social stigma; stress symptom; systematic review; treatment services; violence perpetration

Project Summary Young gay and bisexual men and other men who have sex with men (Y-GBMSM) are at elevated risk for HIV in Kenya, and are a Key Population in the Kenya AIDS Strategic Framework II (2020/21-2024/25). Y-GBMSM experience multiple barriers to accessing quality HIV prevention and care services, and report high levels of discrimination and violence perpetrated by healthcare workers. Criminalization of same-sex behavior and negative societal attitudes toward LGBTQ people lead to persistent experiences of stigma and discrimination. Y-GBMSM in Kenya also report disproportionately high levels of mental health (MH) challenges, in part due to persistent discrimination and violence. Associations between mental health challenges and increased HIV risk behaviors and negative HIV health outcomes have been documented among Y-GBMSM in Kenya. Conversely, positive mental health factors are associated with improved HIV outcomes for this population regardless of their HIV status. Given the multi-faceted associations between MH challenges and HIV prevention and treatment outcomes among Y-GBMSM in Kenya, researchers have recommended the integration of MH and HIV services, as such integration improves patient and service delivery outcomes. In this R-21 application, we will utilize a participatory action research approach to: a) explore how mental health challenges negatively influence progression through both the HIV prevention and HIV care continua for Y-GBMSM in Kisumu, Kenya; b) develop a framework for integrating MH promotion with HIV prevention and care continua services for Y- GBMSM in Kisumu; and c) develop blueprints for mental health promotion program components that could be integrated into HIV prevention and care continua services for Y-GBMSM at four socio-ecological levels: individual, group, clinic/organization, and community. This proposed study will take advantage of analyzing data already collected as part of an ongoing study currently testing an HIV prevention/psychosocial PrEP support intervention for Y-GBMSM in Kisumu [R34-MH-118950-01:Harper,M-PI], and will collect primary data in the form of community charrettes, individual in-depth interviews, and focus group discussions with both Y- GBMSM and service providers. We have a multi-disciplinary Core Research Team of mental health and HIV experts from Kenya and the U.S. that have worked together in Kisumu for 5+ years, and we will have active engagement from Y-GBMSM through our Community Participatory Development Team and from service providers through our Service Providers Development Team. The study builds on Harper's 15+ years working with Y-GBMSM in Kenya. We anticipate that results from this study will have high impact by creating both a framework that can be used to explore advantages/disadvantages of different models of mental health and HIV service integration for Y-GBMSM, and blueprints for mental health promotion components that can be integrated into both HIV prevention and care services at four different socio-ecological levels. Such data will have implications for similar work in other sub-Saharan African settings, as well as inform domestic efforts.

项目概要 年轻男同性恋和双性恋男性以及其他男男性行为者 (Y-GBMSM) 感染艾滋病毒的风险较高 肯尼亚艾滋病战略框架二（2020/21-2024/25）中的重点人群。 Y-GBMSM 在获得优质艾滋病毒预防和护理服务方面遇到多重障碍，并报告高水平 医护人员实施的歧视和暴力行为。将同性行为定为犯罪和 对 LGBTQ 人群的负面社会态度会导致持续的耻辱和歧视经历。 肯尼亚的 Y-GBMSM 还报告了不成比例的高水平心理健康 (MH) 挑战，部分原因是 持续存在的歧视和暴力。心理健康挑战与艾滋病毒风险增加之间的关联 肯尼亚 Y-GBMSM 的行为和艾滋病毒负面健康结果已被记录。反过来， 积极的心理健康因素与该人群的艾滋病毒结果改善相关，无论 他们的艾滋病毒状况。鉴于 MH 挑战与 HIV 预防之间存在多方面的关联， 在肯尼亚 Y-GBMSM 的治疗结果中，研究人员建议将 MH 和 艾滋病毒服务，这样的整合可以改善患者和服务提供的结果。在此 R-21 应用程序中，我们 将利用参与性行动研究方法来：a）探索心理健康如何带来负面挑战 通过肯尼亚基苏木 Y-GBMSM 的艾滋病毒预防和艾滋病毒护理连续性影响进展； b) 制定一个框架，将 MH 促进与 HIV 预防和护理连续服务结合起来，以供 Y- 基苏木 GBMSM； c) 制定心理健康促进计划组成部分的蓝图 在四个社会生态层面纳入 Y-GBMSM 的艾滋病毒预防和护理连续服务： 个人、团体、诊所/组织和社区。这项拟议的研究将利用分析 作为正在进行的研究的一部分已经收集的数据，目前正在测试艾滋病毒预防/心理社会 PrEP 支持基苏木 Y-GBMSM 的干预 [R34-MH-118950-01:Harper,M-PI]，并将收集主要数据 以社区专家研讨会、个人深度访谈以及与 Y 双方进行焦点小组讨论的形式 GBMSM 和服务提供商。我们拥有多学科的心理健康和艾滋病核心研究团队 来自肯尼亚和美国的专家在基苏木合作了 5 年以上，我们将积极 Y-GBMSM 通过我们的社区参与发展团队和服务参与 通过我们的服务提供商开发团队向提供商提供服务。该研究建立在哈珀 15 年以上的工作经验之上 与肯尼亚的 Y-GBMSM 合作。我们预计这项研究的结果将通过创建一个 可用于探索不同心理健康和艾滋病毒模型的优点/缺点的框架 Y-GBMSM 的服务集成，以及可用于心理健康促进组件的蓝图 纳入四个不同社会生态层面的艾滋病毒预防和护理服务。此类数据将 对撒哈拉以南非洲其他地区的类似工作具有影响，并为国内努力提供信息。