Evaluating the effectiveness of a mobile HIV prevention app to increase HIV and STI testing and PrEP initiation among rural men who have sex with men

评估移动艾滋病毒预防应用程序在农村男男性行为者中增加艾滋病毒和性传播感染检测以及 PrEP 启动的有效性

• 批准号: 10743669
• 负责人: Jeb Jones
• 金额: $ 78.57万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10743669
• 关键词: AIDS prevention; Address; Affect; Arkansas; Awareness; Behavioral; Belief; Bisexual; Caring; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Communities; Consensus; Coupled; Data; Diagnosis; Diagnostic Reagent Kits; Discrimination; Effectiveness; Effectiveness of Interventions; Environment; Epidemic; Ethnic Origin; Face; Focus Groups; Frequencies; Funding; Future; Gays; HIV; HIV diagnosis; HIV/STD; Health; Health Personnel; Health Services Accessibility; Home; Human immunodeficiency virus test; Hybrids; Incidence; Intervention; Interview; Knowledge; Leadership; Maintenance; Measures; Methods; Minority; Outcome; Ownership; Participant; Policy Maker; Population; Prevalence; Prevention program; Preventive service; Provider; Race; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Risk Assessment; Rural; STI prevention; Self Administration; Self Efficacy; Social Environment; Stigmatization; Surveys; Testing; Transportation; United States; Urban Population; Work; arm; community organizations; cultural competence; data access; design; effective intervention; effectiveness evaluation; effectiveness outcome; effectiveness-implementation RCT; effectiveness/implementation hybrid; effectiveness/implementation trial; efficacy testing; experience; follow-up; future implementation; health care settings; implementation evaluation; implementation outcomes; implementation strategy; implementation/effectiveness; improved; improved outcome; interest; mHealth; men; men of color; men who have sex with men; mobile application; motivational enhancement therapy; pre-exposure prophylaxis; prevent; prevention service; preventive intervention; rural Americans; rural area; self testing; sexual identity; social health determinants; social stigma; standard of care; telehealth; testing uptake; transmission process; trial design; uptake; willingness

Abstract Uptake of HIV and STI testing among gay and bisexual men who have sex with men (GBMSM) in the rural southern US is low. However, HIV and STI testing is a fundamental gateway to preventive services, such as pre-exposure prophylaxis (PrEP), and treatment provision. Thus, it is critical that we identify methods to increase uptake of HIV and STI testing among this population that experiences disproportionate HIV and STI incidence. We have developed an app, Combine, that is an adaptation of HealthMindr, an app that has demonstrated efficacy in increasing uptake of HIV testing among urban GBMSM. Combine was adapted using input from GBMSM in rural areas to address issues specific to this population such as increased experiences of stigma and reduced access to culturally competent care. We propose to conduct a Type 2 Hybrid Effectiveness-Implementation randomized controlled trial to test the efficacy of Combine to increase uptake of HIV and STI testing over 24 months of follow-up and to examine the effect of different implementation strategies among GBMSM in the rural South. Combine will include components for self-administered risk assessments, developing and supporting a plan for frequent HIV and STI testing, information about PrEP, and PrEP and HIV/STI testing provider locators. Previous trials of app-based HIV prevention have included the ability to order free HIV and STI self-test kits. However, there is not a consensus among health officials around whether at-home self-tests are an optimal solution for increasing HIV and STI testing. Additionally, despite the availability of free HIV and STI self-test kits in previous studies, large proportions of men still do not complete HIV tests and even fewer complete STI tests. Thus, we will evaluate the effect of two different intervention components on HIV and STI uptake in a 2x2 factorial trial design: availability of HIV and STI self-test kits ordered through the app and a motivational interview designed to enhance the existing app content, increase self-efficacy to develop and follow through with a testing plan, and develop strategies to deal with experiences of stigma. All participants will receive the Combine app, including a locator to identify nearby HIV and STI testing centers. Men in the control arm (Arm 1) will not have the ability to order HIV and STI self-test kits and will not receive a motivational interview; men in Arm 2 will not have the ability to order HIV and STI self-test kits but will receive a motivational interview; men in Arm 3 will be able to order free HIV and STI self-test kits but will not receive a motivational interview; and men in Arm 4 will have the ability to order HIV and STI self-test kits and will receive a motivational interview. We will assess the main effects of the availability of HIV and STI self-test kits and the motivational interview on HIV and STI testing uptake, PrEP initiation, and intervention maintenance over 24 months of follow up. Our community-based partner, Engaging Arkansas Communities, will work with us through all stages of the project to ensure that we are obtaining the necessary data to inform future implementation.

抽象的 农村男同性恋者和双性恋者 (GBMSM) 接受艾滋病毒和性传播感染检测的情况 美国南部地势较低。然而，艾滋病毒和性传播感染检测是获得预防服务的基本途径，例如 暴露前预防 (PrEP) 和提供治疗。因此，至关重要的是我们确定方法 增加艾滋病毒和性传播感染感染率过高的人群接受艾滋病毒和性传播感染检测的比例 发生率。我们开发了一款应用程序，Combine，它是 HealthMindr 的改编版，该应用程序具有 已证明在提高城市 GBMSM 中艾滋病毒检测的采用率方面具有功效。结合使用进行了调整 农村地区 GBMSM 的投入，以解决该人群的具体问题，例如增加经验 耻辱和获得文化上合格护理的机会减少。我们建议进行 2 类混合 有效性-实施随机对照试验，测试组合增加摄取的功效 HIV 和 STI 检测超过 24 个月的随访，并检查不同实施方案的效果 南方农村地区 GBMSM 的战略。合并将包括自我管理风险的组件 评估、制定和支持频繁的 HIV 和 STI 检测计划、有关 PrEP 的信息以及 PrEP 和 HIV/STI 检测提供商定位器。之前基于应用程序的艾滋病毒预防试验包括 能够订购免费的艾滋病毒和性传播感染自检套件。然而，卫生官员之间尚未达成共识 家庭自检是否是增加艾滋病毒和性传播感染检测的最佳解决方案。此外，尽管 尽管在之前的研究中提供了免费的艾滋病毒和性传播感染自检试剂盒，但仍有很大一部分男性没有完成 HIV 检测和完整的 STI 检测就更少了。因此，我们将评估两种不同干预措施的效果 2x2 析因试验设计中 HIV 和 STI 吸收的组成部分：HIV 和 STI 自检试剂盒的可用性 通过应用程序订购和动机访谈旨在增强现有的应用程序内容，增加 制定并执行测试计划的自我效能感，并制定应对经历的策略 的耻辱。所有参与者都将收到合并应用程序，包括一个用于识别附近艾滋病毒和性传播感染的定位器 测试中心。对照组（第一组）的男性将无法订购 HIV 和 STI 自检套件，并且 不会接受激励性访谈；第 2 组中的男性将无法订购 HIV 和 STI 自检套件 但会接受励志访谈；第 3 组的男性将能够订购免费的艾滋病毒和性传播感染自检套件，但 不会接受激励性访谈；第 4 组中的男性将能够进行 HIV 和 STI 自检 套件并将接受励志访谈。我们将评估艾滋病毒和性传播感染的主要影响 自检工具包以及关于 HIV 和 STI 检测、PrEP 启动和干预的动机访谈 维护超过24个月的随访。我们的社区合作伙伴“参与阿肯色州社区”， 将在项目的所有阶段与我们合作，以确保我们获得必要的数据来告知 未来的实施。