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.

摘要 增加获得和接受一致的艾滋病毒检测和生物医学预防对于结束 在美国流行的同性恋、双性恋和其他与其他男性发生性行为的男性(MSM)1. 对于城市、非裔美国人或黑人MSM来说尤其如此，他们受到的影响不成比例 艾滋病毒/艾滋病在US2-4中，因此将受益于持续的检测，这是治疗和 预防。纽约市是美国新诊断艾滋病毒感染人数最多的大都会地区 在男男性接触者和中--美国94%的艾滋病毒/艾滋病感染者居住在城市地区。艾滋病病毒 耻辱、PrEP/PEP耻辱和同性恋恐惧症是艾滋病毒检测和预防的关键障碍。交叉感染艾滋病毒- 相关的污名和同性恋恐惧症可能是艾滋病毒检测和预防的特别重大障碍 非裔美国人/黑人男男性接触者，他们检测频率较低，更有可能感染未确诊的艾滋病毒/艾滋病 与白人MSM相比。很少有干预措施被开发和测试来减少交叉感染艾滋病毒 污名和同性恋恐惧症同时或在社区一级，特别是对非裔美国人/黑人MSM。 由研究小组负责人设计和评估的一个例外是CHANGE(挑战艾滋病毒/艾滋病的耻辱和 同性恋恐惧症和获得赋权)，一个社区层面的，基于理论的，反耻辱和反同性恋恐惧症 为艾滋病毒高流行率的非裔美国人城市社区设计的干预措施。在此，我们建议 调整这一社区级别的干预措施，将重点放在减少PrEP/PEP和测试污名上 作为种族主义，在居住在城市地区的非裔美国MSM中增加检测和PrEP/PEP的接受。在……里面 第一阶段，我们将使用群体建模，一种系统科学的方法，来确定因果路径和其他 多层次的社区环境特征提示长葛的适应。在第二阶段，我们 将适应干预应用原则的设计思路和结果进行概念性检验。在这个阶段 我们还将为由此产生的社区层面的大规模试验确定最佳研究设计特征 干预。在第三阶段，我们将对干预措施进行试点测试，包括优化研究设计的各个方面 匹配社区方法。最终结果将是减少交叉感染艾滋病毒，PrEP/PEP， 在种族主义的背景下测试污名和同性恋恐惧症，以及测试干预措施所需的规划 规模化的严谨设计。结果将填补预防科学证据基础中关于干预措施的空白 在艾滋病毒风险最高的人群中增加艾滋病毒检测和PrEP/PEP的使用。