A Pragmatic Trial of An Adaptive eHealth HIV Prevention Program for Diverse Adolescent MSM

针对不同青少年 MSM 的适应性电子健康 HIV 预防计划的务实试验

基本信息

批准号：
9206727
负责人：
Brian Mustanski
金额：
$ 198.77万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-28 至 2021-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9206727
关键词：
AIDS prevention Accounting Adolescent Adolescent Risk Behavior Adolescent and Young Adult Adult Affect Age Behavior Caring Clinical Cost Analysis Data Devices Effectiveness Enrollment Ensure Ethnic Origin Face Future Geographic Locations Goals HIV HIV Infections HIV diagnosis HIV risk Health education Heterosexuals Hispanics Human immunodeficiency virus test Hybrids Incidence Income Infection Intervention Language Latino Lesbian Gay Bisexual Transgender Magic Measures Methodology Methods Minority Modality Parents Participant Population Prevention Prevention program Process Public Health Race Randomized Recording of previous events Risk Behaviors Risk-Taking Rural Sampling Schools Science Services Sexual Health Sexual and Gender Minorities Socioeconomic Status Testing United States National Institutes of Health Update Vulnerable Populations Work Youth base community organizations cost cost effectiveness design eHealth efficacy testing evidence base experience health disparity implementation trial improved innovation intervention effect male health meetings men who have sex with men motivational enhancement therapy pragmatic trial prevention service programs public health relevance queer randomized trial response sex sexual minority sexually active therapy design transmission process trial design young man young men who have sex with men

项目摘要

Project Summary Adolescent (ages 13-18) men who have sex with men (AMSM) experience a dramatic health disparity as they represent 2% of young people but account for almost 80% of HIV diagnoses. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (community organizations, schools, parents), have significant limitations when it comes to AMSM. eHealth interventions represent an excellent modality for delivering AMSM-specific intervention material where youth “are.” We should not continue to deliver the same intervention when a participant is not responding. Rather, stepped-care strategies increase in intensity to meet the needs of those who do not respond to a less intense intervention. Using a Sequential Multiple Assignment Randomized Trial (SMART) design, we will evaluate the impact of a package of increasingly intensive interventions that have already shown evidence of efficacy with diverse adolescent and young adult MSM. The SMART design is an ideal approach to achieve the goals of this RFA because SMART designs mimic treatment decisions as they are made in real-world clinical settings. Collectively we brand our package of eHealth interventions as the SMART Program (Sexual Minority Adolescent Risk Taking). The Program package includes: (1) a universally-delivered, brief, online sexual health education program designed for sexual and gender minority youth regardless of whether they are sexually active (Queer Sex Ed); (2) a more intensive online intervention designed for diverse AMSM engaging in HIV transmission risk behaviors (Keep It Up!), and (3) the most intensive is a motivational interviewing (MI) intervention that will be delivered by MI therapists via online videochat (Young Men's Health Project). We will evaluate SMART Program impact and inform future implementation with three specific aims. Aim 1 is to test impact of the SMART Program and its constituent components on reducing HIV risk and increasing testing among. We will developmentally adapt existing content for AMSM using the ADAPT-ITT framework and linguistically adapt the SMART Program to Spanish speaking Latino AMSM. We will enroll a national sample of 1,878 diverse AMSM and test the efficacy of the Program using a SMART design. Aim 2 is to test if the SMART Program has differential efficacy across important sub-groups of AMSM based on race/ethnicity, urban/rural, age, socioeconomic status, and language. Aim 3 is to evaluate the delivery of the SMART Program nationally to inform its implementation and cost-effectiveness. To minimize the science-practice gap, we will utilize mixed methods to identify facilitators and barriers to the implementation of the SMART Program and its core components by collecting measures from the RE-AIM framework and performing cost analysis.

项目概要男男性行为者 (AMSM) 的青少年（13-18 岁）健康状况存在巨大差异尽管他们占年轻人的 2%，但占艾滋病毒诊断的近 80%。负担过重，而且明显缺乏基于证据的艾滋病毒预防计划。作为传统的艾滋病毒预防提供渠道（社区组织、 AMSM 的电子健康干预措施具有显着的局限性。在年轻人“所在”的地方提供针对 AMSM 的干预材料的绝佳方式。当参与者没有回应时，我们不应该继续提供相同的干预。阶梯式护理策略增加强度，以满足那些对强度较低的护理没有反应的人的需求使用序贯多重分配随机试验（SMART）设计，我们将评估干预。一揽子日益强化的干预措施的影响已经显示出有效性的证据 SMART 设计是实现这一目标的理想方法。 RFA 因为 SMART 设计模仿了现实临床中做出的治疗决策我们将我们的电子健康干预措施统称为 SMART 计划（性少数群体）。该计划包包括：(1) 普遍提供的、简短的在线性健康。为性少数和性别少数青年设计的教育计划，无论他们是否有性倾向积极（酷儿性教育）；(2) 为参与艾滋病毒的不同 AMSM 设计的更深入的在线干预措施传播风险行为（坚持下去！），以及（3）最密集的是动机访谈（MI） MI 治疗师将通过在线视频聊天进行干预（我们将进行青年男性健康项目）。评估 SMART 计划的影响并为未来的实施提供三个具体目标。目标 1 是测试 SMART 计划及其组成部分对降低 HIV 风险和我们将使用 ADAPT-ITT 开发性地调整 AMSM 的现有内容。框架并在语言上使 SMART 计划适应讲西班牙语的拉丁裔 AMSM。对 1,878 个不同 AMSM 进行全国抽样，并使用 SMART 设计测试该计划的功效。目标 2 是测试 SMART 计划在 AMSM 的重要亚组中是否具有差异功效基于种族/民族、城市/乡村、年龄、社会经济地位和语言。目标 3 是评估 SMART 计划在全国范围内的实施情况，以告知其实施情况和为了最大限度地减少科学与实践之间的差距，我们将利用混合方法来确定促进者。通过收集措施来分析实施 SMART 计划及其核心组成部分的障碍来自 RE-AIM 框架并进行成本分析。