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 在农村与男人发生性关系的同性恋和双性恋男人中的艾滋病毒和性传播感染测试 美国南部很低。但是，艾滋病毒和性传播感染测试是预防服务的基本门户，例如 暴露前预防（PREP）和治疗条款。因此，至关重要的是我们确定方法 在该人群中增加艾滋病毒和性传播感染测试的摄取，使艾滋病毒比例不成比例 发病率。我们已经开发了一个应用程序Combine，那是对HealthMindr的改编，该应用程序具有 在城市GBMSM中增加了艾滋病毒测试的摄取量增加了功效。联合收割机是使用的 农村地区GBMSM的投入解决特定人群的问题，例如增加经验 污名和减少获得文化胜任的护理的机会。我们建议进行2型混合动力车 有效实施随机对照试验，以测试联合收割机的功效以增加吸收 艾滋病毒和STI测试超过24个月的随访，并检查不同实施的效果 南部农村地区GBMSM的策略。联合收割机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测试计划，有关PREP的信息以及 PREP和HIV/STI测试提供商定位器。以前对基于应用程序的HIV预防的试验包括 能够订购免费的艾滋病毒和STI自我测试套件。但是，卫生官员周围没有达成共识 在家自我测试是否是增加艾滋病毒和性传播感染测试的最佳解决方案。此外，尽管有 在先前的研究中，免费的艾滋病毒和STI自我测试套件可获得，大量男性仍未完成 HIV测试，甚至更少的完整性传播感染测试。因此，我们将评估两种不同的干预措施的效果 2x2阶乘试验设计中的HIV和STI吸收的组件：艾滋病毒和STI自我测试套件的可用性 通过应用程序订购和旨在增强现有应用程序内容的励志采访，增加 自我效能以制定和遵循测试计划，并制定策略来处理经验 污名。所有参与者将收到联合收割机应用程序，包括一个定位器来识别附近的艾滋病毒和STI 测试中心。控制臂中的男人（ARM 1）将没有订购艾滋病毒和STI自我测试套件的能力，并且 不会接受励志采访； ARM 2中的男人将无法订购艾滋病毒和STI自我测试套件 但会接受励志采访；手臂3中的男性将能够订购免费的艾滋病毒和STI自我测试套件，但 不会接受励志采访；第4臂中的男人将有能力订购艾滋病毒和STI自我测试 套件并将获得激励性采访。我们将评估HIV和STI的可用性的主要影响 自测套件以及有关艾滋病毒和STI测试吸收，准备启动和干预的动机访谈 维护24个月的随访。我们社区的合作伙伴吸引了阿肯色州社区， 将通过项目的所有阶段与我们合作，以确保我们获得必要的数据以告知 未来的实施。