Optimizing Study Design to Test a Community-level Intervention to Reduce Intersectional Stigma and Increase HIV Testing and Prevention among African-American/Black MSM

优化研究设计以测试社区层面的干预措施，以减少非洲裔美国人/黑人男男性接触者中的交叉耻辱并增加艾滋病毒检测和预防

• 批准号: 10159980
• 负责人: Victoria Frye
• 金额: $ 19.64万
• 依托单位: CITY COLLEGE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-07 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10159980
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Affect; African; African American; Area; Attitude; Awareness; Belief; Big Data; Bisexual; Cluster randomized trial; Color; Communities; Community Trial; Conscious; Discrimination; Education; Educational process of instructing; Empathy; Environment; Epidemic; Family; Gays; HIV; HIV Infections; Health; Homophobia; Human immunodeficiency virus test; Individual; Interruption; Intervention; Lesbian Gay Bisexual Transgender Queer; Methods; Modality; Modeling; Names; Neighborhoods; Newly Diagnosed; Outcome; Outcome Measure; Pathway interactions; Phase; Population; Prevalence; Prevention; Process; Public Health; Research; Research Design; Research Personnel; Risk; Sampling; Science; Site; Societies; Stereotyping; Stigmatization; Structure; System; Techniques; Testing; Thinking; United States; Urban Community; Viral Load result; antiretroviral therapy; base; black men who have sex with men; community intervention; design; empowerment; evidence base; experience; men; men who have sex with men; metropolitan; model building; novel; pilot trial; pre-exposure prophylaxis; preventive intervention; prototype; racism; skills; social; social stigma; testing access; testing uptake; theories; therapy design; uptake; urban area

ABSTRACT Increasing access to and uptake of consistent HIV testing and biomedical prevention is critical to ending the epidemic in the United States (US) among gay, bisexual and other men who have sex with other men (MSM)1. This is particularly true for urban, African-American or Black MSM, who are disproportionately affected by HIV/AIDS in the US2-4 and would thus benefit from consistent testing, which is the gateway to treatment and prevention. NYC is the metropolitan area in the US with the largest number of newly diagnosed HIV infections among MSM and 89-94% of all people living with HIV/AIDS (PLWHA) in the US reside in urban areas. HIV stigma, PrEP/PEP stigma and homophobia are key barriers to HIV testing and prevention. Intersectional HIV- related stigmas and homophobia may be especially significant barriers to HIV testing and prevention among African-American/Black MSM, who test less often and are more likely to live with undiagnosed HIV/AIDS compared with white MSM. Few interventions have been developed and tested to reduce intersectional HIV stigmas and homophobia simultaneously or at the community level, particularly for African-American/Black MSM. One exception, designed and evaluated by study team leads is CHHANGE (Challenge HIV/AIDS Stigma & Homophobia and Gain Empowerment), a community-level, theory-based, anti-stigma and -homophobia intervention designed for African-American urban neighborhoods with high HIV prevalence. Here we propose to adapt this community-level intervention to include a focus on reducing PrEP/PEP and testing stigmas, as well as racism, to increase testing and PrEP/PEP uptake among African-American MSM living in urban areas. In Phase 1, we will use group model building, a systems science method, to identify causal pathways and other features of multiple levels of the community environment to inform the adaptation of CHHANGE. In Phase 2, we will adapt the intervention applying principles of design thinking and results will be concept tested. In this phase we will also identify optimal study design features for a large-scale trial of the resultant community-level intervention. In Phase 3, we will pilot test the intervention, including aspects of the optimized study design, in a matched-community approach. The final result will be an intervention to reduce intersectional HIV, PrEP/PEP, testing stigmas and homophobia, in the context of racism, and the planning required to test the intervention using a rigorous design at scale. Results will fill a gap in the prevention science evidence base around interventions to increase HIV testing and PrEP/PEP use among populations most at risk for HIV.

抽象的 增加对HIV测试和生物医学预防的访问和吸收的机会和吸收对于结束而言至关重要 同性恋，双性恋和其他与其他男人发生性关系（MSM）1的男同性恋者中的流行病（美国）1。 对于城市，非裔美国人或黑人MSM而言，这尤其如此，他们受到不成比例的影响 US2-4中的艾滋病毒/艾滋病，因此将受益于一致的测试，这是治疗的门户， 预防。纽约市是美国的大都市地区，新近诊断的艾滋病毒感染数量最多 在MSM和89-94％的美国艾滋病毒/艾滋病（PLWHA）中，美国居住在城市地区。艾滋病病毒 污名，准备/PEP污名和同性恋恐惧症是HIV检测和预防的关键障碍。交叉HIV- 相关的污名和同性恋恐惧症可能是艾滋病毒测试和预防的特别障碍 非裔美国人/黑色MSM，他的测试频率较低，更有可能与未诊断的艾滋病毒/艾滋病相处 与白色MSM相比。几乎没有开发和测试以减少交叉HIV的干预措施 同时或在社区层面，特别是对于非裔美国人/黑人MSM的污名和同性恋恐惧症。 由研究团队负责人设计和评估的一个例外是Chhange（挑战艾滋病毒/艾滋病的污名和 同性恋恐惧症和增强能力），一种基于理论的，抗耻辱和 - 恐惧症的社区级别 为艾滋病毒率高的非裔美国城市社区设计的干预措施。在这里我们建议 适应这种社区级干预措施，包括关注减少准备/PEP和测试污名 作为种族主义，以增加居住在城市地区的非裔美国人MSM的测试和准备/PEP吸收。在 第1阶段，我们将使用系统科学方法的组模型构建来识别因果途径和其他 社区环境的多个层次的特征，以告知Chhange的适应。在第2阶段，我们 将适用于应用设计思维原则和结果的干预措施进行概念测试。在这个阶段 我们还将确定最佳的研究设计功能，以进行最终的社区级别的大规模试验 干涉。在第3阶段中，我们将试点测试干预措施，包括优化研究设计的各个方面 匹配的社区方法。最终结果将是减少艾滋病毒相交的干预措施，Prep/pep， 在种族主义的背景下，测试污名和同性恋恐惧症，以及使用 严格的设计。结果将填补围绕干预措施的预防科学证据的空白 增加最有艾滋病毒风险的人群中的艾滋病毒测试和PEP/PEP使用。