Examining a Multicomponent Intervention to Improve HIV Health among Black Men in Southern Ending the HIV Epidemic in the U.S. Jurisdictions

检查改善南部黑人男性艾滋病毒健康的多成分干预措施，结束美国司法管辖区的艾滋病毒流行

• 批准号: 10744410
• 负责人: Devin English
• 金额: $ 70.09万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10744410
• 关键词: Address; Anxiety; Area; Behavioral; Caring; Collaborations; Communities; Economics; Effectiveness; Elements; Ensure; Epidemic; Evaluation; Evidence based intervention; Fostering; Funding; HIV; HIV diagnosis; HIV disparities; Health; Health Promotion and Education; Health Status; Health behavior; Health education; Healthcare; Housing; Hybrids; Individual; Inequity; Institution; Intervention; Leadership; Link; Maintenance; Mental Health; Mental health promotion; Methods; Modeling; Monitor; Motivation; National Institute of Mental Health; Outcome; Pathway interactions; Patient Self-Report; Population; Race; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Personnel; Resource-limited setting; Running; Service delivery model; Social Work; Social isolation; Social support; Testing; Time; Transportation; Unsafe Sex; Waiting Lists; antiretroviral therapy; anxiety symptoms; arm; behavioral health; behavioral outcome; black men; black men who have sex with men; combat; community based participatory research; community organizations; depressive symptoms; diaries; effective intervention; effectiveness testing; effectiveness/implementation trial; emotion dysregulation; emotion regulation; empowerment; evidence base; experience; implementation design; improved; improved outcome; innovation; member; multi-component intervention; multidisciplinary; pilot trial; primary outcome; psychologic; psychological outcomes; research study; secondary outcome; sexual minority; skills; social capital; social stigma; substance use; theories; therapy design; treatment adherence; trend; uptake

PROJECT SUMMARY/ABSTRACT Black men who have sex with men (BMSM) in the U.S. continue to experience a vastly inequitable HIV burden, particularly in Southern Ending the HIV Epidemic in the U.S. (EHE) jurisdictions. To combat this alarming trend, there is a need for innovative, accessible, and community-developed interventions to promote HIV health among BMSM in these areas. Given research that daily and multilevel intersectional stigma contributes to HIV inequities among BMSM, a multicomponent intervention that addresses multilevel barriers to HIV health and combats intersectional stigma is essential. In collaboration with THRIVE SS, a leading BMSM- led community-based organization serving BMSM living with HIV in the Atlanta area, we developed THRIVE365, an evidence-based multicomponent HIV intervention that provides individual-level health education and motivation, builds social support among BMSM, facilitates access to culturally-affirmative healthcare, and combats barriers to housing and economic empowerment in line with the Information- Motivation-Behavioral skills, social capital, and socioecological models of health. Pilot evidence indicates THRIVE365 is feasible, acceptable, and efficacious in promoting daily antiretroviral treatment (ART) adherence and reducing daily depressive symptoms, anxiety symptoms, and emotion regulation difficulties among BMSM living with HIV. THRIVE365 is ready for a full-scale evaluation guided by the RE-AIM framework that includes a robust examination of its effectiveness for HIV-related behavioral and psychological outcomes, its moderation effects on intersectional stigma, and its maintenance and reach over time. We will do so with a fully-powered hybrid type 2 implementation-effectiveness trial using daily diary methods, self-report follow-ups over 6 months, and paradata to examine daily and longer-term intervention engagement, effects, and adaptations. The overarching aims of this research are to: 1) Test the effectiveness of THRIVE365 in improving daily and longer-term HIV-related behavioral health (primary outcome: ART adherence) and psychological health (e.g., secondary outcomes: lower depressive and anxiety symptoms) in a 6-month waitlist randomized controlled trial with 350 BMSM living with HIV in the four Atlanta-area EHE jurisdictions; 2) Examine the moderating effect of THRIVE365 on associations between intersectional stigma and our primary and secondary HIV outcomes; 3) Evaluate THRIVE365 maintenance and reach at the user-level (e.g., within-user changes in engagement and daily effects) and setting-level (e.g., intervention adaptations, BMSM community uptake). Together, these results will establish the effectiveness of THRIVE365, a community-led, multicomponent intervention, for improving HIV-related behavioral and psychological health among BMSM living with HIV in four of the EHE jurisdictions with the greatest HIV burden. THRIVE365 was designed for implementation and is poised to offer a model for effective HIV care among BMSM in high-stigma, low-resource areas of the U.S. South and beyond.

项目概要/摘要 美国男男性行为黑人 (BMSM) 继续经历着极其不公平的艾滋病毒感染 负担，特别是在美国南方结束艾滋病毒流行 (EHE) 管辖区。为了解决这个问题 令人震惊的趋势，需要创新的、易于使用的、社区制定的干预措施来促进 这些地区 BMSM 的艾滋病毒健康状况。鉴于研究表明日常和多层次的交叉耻辱 BMSM 是一种多成分干预措施，旨在解决艾滋病毒感染的多层次障碍，从而导致艾滋病毒不平等 艾滋病毒健康和消除交叉污名至关重要。与领先的 BMSM-THRIVE SS 合作 我们开发了一个领导社区组织，为亚特兰大地区感染艾滋病毒的 BMSM 提供服务 THRIVE365，一种基于证据的多成分艾滋病毒干预措施，可提供个人层面的健康 教育和激励，在 BMSM 中建立社会支持，促进获得文化肯定 医疗保健，并根据信息消除住房和经济赋权的障碍 动机-行为技能、社会资本和健康的社会生态模型。试点证据表明 THRIVE365 在促进日常抗逆转录病毒治疗 (ART) 依从性方面是可行、可接受且有效的 减少 BMSM 日常抑郁症状、焦虑症状和情绪调节困难 感染艾滋病毒。 THRIVE365 已准备好在 RE-AIM 框架的指导下进行全面评估，其中包括 对其对艾滋病毒相关行为和心理结果的有效性及其调节进行严格检查 对交叉耻辱及其随时间的维持和影响的影响。我们将用一个全功率的 混合型 2 实施效果试验，采用每日日记法，自我报告随访 6 次以上 月和paradata来检查日常和长期的干预参与、效果和适应。 本研究的总体目标是： 1) 测试 THRIVE365 在改善日常和 与艾滋病毒相关的长期行为健康（主要结果：ART 依从性）和心理健康（例如， 次要结果：在为期 6 个月的候补随机对照试验中降低抑郁和焦虑症状 在亚特兰大地区的四个 EHE 辖区，有 350 名 BMSM 感染艾滋病毒； 2）检验调节作用 THRIVE365 关于交叉耻辱与我们的主要和次要艾滋病毒结果之间的关联； 3） 评估 THRIVE365 维护和用户级别的覆盖范围（例如，用户内部参与度和参与度的变化） 日常影响）和设置水平（例如干预措施适应、BMSM 社区吸收）。在一起，这些 结果将确定 THRIVE365 的有效性，THRIVE365 是一种社区主导的多成分干预措施， 改善四个 EHE 中感染 HIV 的 BMSM 的 HIV 相关行为和心理健康 艾滋病毒负担最重的司法管辖区。 THRIVE365 专为实施而设计，并准备提供 在美国南部及其他地区的耻辱感高、资源匮乏的地区，BMSM 中的有效艾滋病毒护理模式。