Mobilizing Social Network Resources for HIV Care Support: Development and Testing of an Intervention for HIV-Positive MSM in St. Petersburg, Russia

动员社交网络资源支持艾滋病毒护理：俄罗斯圣彼得堡艾滋病毒阳性男男性接触者干预措施的开发和测试

• 批准号: 10160227
• 负责人: Yuri A Amirkhanian
• 金额: $ 21.23万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-11-17 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10160227
• 关键词: Acquired Immunodeficiency Syndrome; Adherence; Advocacy; Affect; Age; Alcohol abuse; Appointment; Caregivers; Caring; Characteristics; Communities; Counseling; Country; Development; Epidemic; Ethics; Face; Family member; Feedback; Feeling; Friends; HIV; HIV Infections; HIV Seropositivity; Health; Health Benefit; Individual; Infection; Injections; Intervention; Intervention Studies; Interview; Lesbian Gay Bisexual Transgender; Life; Link; Mediating; Medical; Outcome; Participant; Personal Satisfaction; Persons; Pharmaceutical Preparations; Phase; Preparation; Prevalence; Procedures; Public Health; Qualitative Research; Randomized; Recommendation; Reporting; Research; Research Methodology; Resources; Risk Behaviors; Russia; Same-sex; Services; Sex Orientation; Sexual Transmission; Social Development; Social Network; Social support; Speed; Stigmatization; Supportive care; Testing; Treatment Efficacy; Viral; Viral Load result; Visit; Work; antiretroviral therapy; base; community setting; comparison group; coping; data format; disease transmission; effectiveness evaluation; experience; follow-up; group intervention; implementation evaluation; implementation intervention; improved; injection drug use; member; men who have sex with men; post intervention; prevent; primary outcome; psychosocial; psychosocial adjustment; recruit; referral services; resilience; same sex behavior; secondary outcome; self esteem; social; social exclusion; social group; social stigma; sociodemographics; substance use; therapy design; therapy development; treatment adherence; treatment as prevention; uptake

ABSTRACT Russia is one of five countries that account for the greatest number of infections in the world. Although historically associated with drug injection, Russia’s HIV epidemic is now primarily sexual, with a large number of infections among MSM. With few supports for medical care engagement, most HIV-positive MSM in Russia have unsuppressed viral load, fueling high continued disease transmission and poor health outcomes. HIV care engagement, adherence, and psychosocial coping are better among persons with supportive social resources. Given the hostile social circumstances they face, improved social supports are critical for the medical care engagement and psychosocial adjustment of HIV-positive MSM in Russia. This study will test an approach to help out-of-care, HIV-positive MSM identify, access, and mobilize social resources to support HIV care engagement. The mixed-methods research will begin with a formative phase of in-depth interviews with 25 PLH MSM in St. Petersburg as well as one supportive resource network member in the life of each participant to characterize the kinds of social resources that can be harnessed to support HIV care. Formative data and input from the study’s Community Advisory Panel will inform the tailoring of an intervention that has already been successfully pilot tested. The intervention study will recruit 100 out-of-care HIV+ MSM in community settings and online. After completing baseline assessments, participants will be randomized to either an individual care counseling (ICC) comparison condition or ICC plus a social support mobilization (SSM) intervention. In it, PLH MSM will attend five main and two booster sessions that underscore the benefits of medical care engagement, counter the effects of internalized intersectional stigma and promote resilience, and help participants develop and mobilize social resources supportive of HIV care. Support mobilization will begin by assisting participants develop care-supportive bonds with other group members, PLH friends, and connections made with LGBT and PLH NGOs. They will also be guided in developing and expanding supportive links with affirmative friends, family members, and other resources. In this way, the intervention will bolster care-related social support resources, resilience, and feelings of self-worth. Assessments administered at baseline will be repeated 6 and 12 months post-intervention, and in-depth followup interviews will be conducted with a subset of 20 participants to elicit feedback about the intervention experience. We hypothesize that the SSM intervention will produce greater preliminary evidence of benefit on the primary outcome of medical care attendance in the past 6 months and on secondary outcomes of having undetectable viral load, ART adherence, and psychosocial well-being. We will explore whether care-related outcomes are mediated by increases in social resources and other factors. If there is evidence of benefit, the intervention will be offered to the former comparison group as an ethical service after the final followup. If project findings are successful, we will plan a later evaluated full-scale implementation of the intervention.

摘要 俄罗斯是世界上感染人数最多的五个国家之一。虽然 从历史上看，俄罗斯的艾滋病毒流行与注射毒品有关，现在主要是性传播，有大量 男男性接触者感染的可能性。由于对医疗服务的支持很少，俄罗斯大多数艾滋病毒阳性的男男性接触者 病毒载量未受抑制，助长了疾病的高持续传播和不良的健康结果。艾滋病病毒 在支持社会的人中，关爱参与度、依从性和心理社会应对能力更好 资源。考虑到他们面临的敌对社会环境，改善社会支持对他们来说至关重要 俄罗斯HIV阳性男男性接触者的医疗参与和心理社会适应。这项研究将测试一个 帮助脱离护理的艾滋病毒阳性男男性行为者识别、获得和动员社会资源以支持艾滋病毒的方法 关爱参与。混合方法的研究将从形成阶段开始，深入采访 圣彼得堡的25名PLH MSM以及每个人的生活中的一名支持性资源网络成员 参与者描述可用于支持艾滋病毒护理的社会资源的种类。形成性 这项研究的社区咨询小组的数据和输入将为干预措施的定制提供信息 已经成功地进行了试运行测试。这项干预研究将招募100名出院HIV+MSM 社区设置和在线。在完成基线评估后，参与者将被随机分配到 个人护理咨询(ICC)比较条件或ICC加社会支持动员 (SSM)干预。在其中，PLH MSM将参加五个主要会议和两个强化会议，以强调好处 医疗参与，抵消内在化的跨部门污名的影响，促进复原力， 并帮助参与者开发和动员支持艾滋病毒护理的社会资源。支持动员将 首先，帮助参与者与其他小组成员、PLH朋友和 与LGBT和PLH非政府组织建立联系。还将指导它们的发展和壮大 与积极的朋友、家人和其他资源建立支持性联系。通过这种方式，干预将 支持与护理相关的社会支持资源、韧性和自我价值感。管理的评估 在干预后6个月和12个月将重复基线，并将进行深入的后续访谈 对20名参与者进行调查，以获取对干预体验的反馈。我们 假设SSM干预将产生更多初步证据，证明在初级保健方面受益 过去6个月就诊的结果和无法检测到的继发结果 病毒载量、抗逆转录病毒治疗依从性和社会心理健康。我们将探索与护理相关的结果是否 受社会资源增加和其他因素的影响。如果有证据表明这是有益的，干预将 在最后一次随访后作为伦理服务提供给前对照组。如果项目调查结果是 如果成功，我们将计划稍后评估全面实施干预措施。