Building mobile HIV prevention and mental health support in low-resource settings

在资源匮乏的地区建立流动艾滋病毒预防和心理健康支持

基本信息

批准号：
10632778
负责人：
Corina Lelutiu-Weinberger
金额：
$ 76.83万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-05 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10632778
关键词：
AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Affect Alcohol abuse Alcohol consumption Appalachian Region Attention Automobile Driving Behavior Therapy Behavioral Biological Bisexual Bypass Cognitive Collaborations Communities Conscious Country Dangerousness Data Discrimination Eastern Europe Education Ensure Epidemic Europe European European Union Evaluation Face Gays HIV HIV Infections HIV Seropositivity HIV risk HIV/STD Health Health Personnel Health Services Healthcare High Prevalence Homophobia Income Infection International Intervention Interview Investments Knowledge Learning Module Locales Mediating Mental Depression Mental Health Modeling Motivation Nature Nongovernmental Organizations Outcome Measure Persons Phase Plant Roots Population Prevalence Prevention Preventive service Professional counselor Provider Randomized Randomized Controlled Trials Reporting Research Resource-limited setting Resources Risk Romania Route Rural Appalachia STI prevention Sampling Self Administration Self Efficacy Services Site Symptoms Testing Training Translating Travel Treatment Efficacy United States National Institutes of Health Vulnerable Populations alcohol testing attentional control base comparison intervention condomless anal sex condoms coping mechanism cost cost effective cost effectiveness cost estimate design efficacy testing follow-up future implementation high risk population improved mHealth male male health member men men who have sex with men minority stress motivational enhancement therapy physical conditioning pilot test pre-exposure prophylaxis prevent prevention service primary outcome psychosocial recruit response screening secondary outcome self esteem sex skills skills training social stigma stem syndemic theories tool transmission process treatment as usual

项目摘要

Project Summary This project is designed to remedy unaddressed and interlocking HIV-prevention and mental health needs among gay and bisexual men (GBM) in the Central Eastern European country of Romania, and their underpinning stigma-related mechanisms. Rampant stigma contributes to the increasing prevalence of HIV among Romanian GBM (from under 10% in 2009 to close to 20% in 2014, by best available estimates) and keeps GBM out-of-reach of HIV-prevention services. Our mHealth pilot intervention (titled “Despre Mine. Despre Noi.” [DMDN] translated as “About Me. About Us.”), which reduced US and Romanian GBM’s risk for HIV infection while also reducing depression and alcohol abuse in initial pre-post trials, is now ready for testing in a randomized controlled trial with a large national sample. The DMDN intervention entails eight 60-minute live chat sessions delivered by trained counselors on our mobile study platform using motivational interviewing (MI) and cognitive-behavioral skills training (CBST). First, during pre-trial (mos 1-5), in collaboration with a community advisory board consisting of GBM community members, GBM-affirmative physical and mental health providers, and our technical developer, we will fine-tune the DMDN intervention based on our pilot findings and evaluation interviews, and expand the original DMDN education materials for an education attention condition (EAC) that will serve as our control. Second, during the intervention phase (mos 6-45), we will recruit, screen, assess, and randomize GBM at risk for HIV infection and alcohol abuse to either the DMDN intervention (n=163) or EAC (n=163). The conditions are content matched, and both are hosted on our study platform. While DMDN will consist of eight weekly mHealth live chat sessions, EAC will consist of eight self- administered educational modules. Third, during the follow-up phase (mos 8-55), we will assess at 4, 8, and 12 months post-baseline, in a mobile fashion identical to the baseline, the primary outcome of condomless anal sex with male partners and secondary outcomes of alcohol abuse, depression, biologic HIV/STI infection, HIV/STI testing, and psychosocial mechanisms rooted in the Information-Motivation-Behavioral Skills (IMB) model (e.g., HIV/STI knowledge, condom use self-efficacy) and minority stress theory (e.g., identity concealment, internalized homophobia). We hypothesize that 1) compared to GBM randomized to EAC, those randomized to the mHealth DMDN condition will report significant reductions in condomless anal sex across the 12-month follow-up, 2) IMB and minority stress mechanisms will statistically mediate intervention efficacy, and 3) compared to EAC, the DMDN intervention will prove cost-effective in terms of HIV infections averted and reduced depression and alcohol abuse. If efficacious and cost-effective, DMDN presents a highly disseminable intervention that could significantly prevent HIV infection among GBM in high-stigma, low- resource areas, where GBM are disproportionately affected by HIV, yet kept out-of-reach of brick-and-mortar prevention services.

项目概要该项目旨在弥补未解决且相互关联的艾滋病毒预防和心理健康需求中东欧国家罗马尼亚的同性恋和双性恋男性 (GBM) 以及他们的情况猖獗的耻辱导致艾滋病毒流行率不断上升。罗马尼亚 GBM（根据现有最佳估计，从 2009 年的不到 10% 上升到 2014 年的接近 20%）使 GBM 远离艾滋病毒预防服务。 Despre Noi。”[DMDN] 翻译为“关于我。”），这降低了美国和罗马尼亚 GBM 的风险。在最初的前后试验中，艾滋病毒感染还可以减少抑郁症和酗酒，现在已准备好进行测试 DMDN 干预需要 8 次，每次 60 分钟。由训练有素的辅导员在我们的移动学习平台上使用动机访谈进行实时聊天会话 (MI) 和认知行为技能培训 (CBST) 首先，在预审期间（第 1-5 段），与培训机构合作。由 GBM 社区成员、GBM 身体和心理肯定成员组成的社区咨询委员会医疗服务提供者和我们的技术开发人员，我们将根据我们的试点调整 DMDN 干预措施调查结果和评估访谈，并扩展原始 DMDN 教育材料的教育第二，在干预阶段（mos 6-45），我们将注意力条件（EAC）作为我们的控制。将招募、筛查、评估和随机分配有 HIV 感染和酗酒风险的 GBM 到 DMDN 干预 (n=163) 或 EAC (n=163) 条件内容匹配，并且两者都在我们的研究中进行。 DMDN 将包括每周八次的移动医疗实时聊天会议，而 EAC 将包括八次自助会议。第三，在后续阶段（第 8-55 个月），我们将在 4、8 和 12 点进行评估。基线后几个月，以与基线相同的移动方式，无套肛门的主要结果与男性伴侣的性行为以及酗酒、抑郁、生物性艾滋病毒/性传播感染等次要结果， HIV/STI 检测以及植根于信息-动机-行为技能 (IMB) 的心理社会机制模型（例如，艾滋病毒/性传播感染知识、安全套使用自我效能）和少数群体压力理论（例如，身份隐瞒、内在的恐同症），我们勇敢地承认 1) 与随机分配到 EAC 的 GBM 相比，那些随机分配到 mHealth DMDN 条件将报告无安全套肛交的显着减少 12 个月的随访，2) IMB 和少数民族压力机制将密切调节干预效果， 3) 与 EAC 相比，DMDN 干预在避免 HIV 感染方面将证明具有成本效益如果有效且具有成本效益，DMDN 可以减少抑郁症和酗酒。传播干预措施可以显着预防高耻辱、低收入人群中 GBM 中的 HIV 感染资源地区，GBM 受艾滋病毒影响尤为严重，但实体设施无法覆盖预防服务。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A randomized controlled trial of an mHealth intervention for gay and bisexual men's mental, behavioral, and sexual health in a high-stigma, low-resource context: Project Comunică protocol.

一项在高耻辱、低资源背景下对男同性恋和双性恋男性的心理、行为和性健康进行 mHealth 干预的随机对照试验：Project Comunicä 协议。

DOI：
10.21203/rs.3.rs-3008174/v1
发表时间：
2023
期刊：
Research square
影响因子：
0
作者：
Lelutiu-Weinberger,Corina;Filimon,Mircea;Hoover,Donald;Lixandru,Mihai;Hanu,Lucian;Dogaru,Bogdan;Kovaks,Tudor;Fierbinteanu,Cristina;Ionescu,Florentina;Manu,Monica;Maris,Alexandra;Pana,Elena;Dorobantescu,Cristian;Streinu-Cercel,Ad
通讯作者：
Streinu-Cercel,Ad