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艾滋病毒/艾滋病的蔓延至关重要。 在美国（US），同性恋、双性恋和其他与其他男性发生性关系的男性（MSM）中流行1。 这对于城市、非洲裔美国人或黑人男男性行为者来说尤其如此，他们不成比例地受到 艾滋病毒/艾滋病在美国2 -4，因此将受益于一致的测试，这是通往治疗和 预防纽约市是美国新诊断艾滋病毒感染人数最多的大都市地区 在美国，89-94%的艾滋病毒/艾滋病（PLWHA）感染者居住在城市地区。艾滋病毒 污名化、PrEP/PEP污名化和仇视同性恋是艾滋病毒检测和预防的主要障碍。交叉HIV- 相关的耻辱和同性恋恐惧症可能是艾滋病毒检测和预防的特别重要的障碍， 非裔美国人/黑人男男性行为者，他们检测频率较低，更有可能患有未确诊的艾滋病毒/艾滋病 与白色MSM相比。几乎没有制定和测试干预措施来减少交叉艾滋病毒 同时或在社区一级，特别是对非洲裔美国人/黑人男男性行为者的污名和同性恋恐惧症。 一个例外，由研究小组负责人设计和评估的是CHHANGE（挑战艾滋病毒/艾滋病污名和 同性恋恐惧症和获得权力），一个社区一级的，以理论为基础的，反污名和反同性恋恐惧症 针对艾滋病高发的非洲裔美国人城市社区的干预措施。在此，我们建议 调整这种社区一级的干预措施，包括重点减少PrEP/PEP和测试耻辱，以及 作为种族主义，以增加测试和PrEP/PEP吸收非洲裔美国人的男男性行为者生活在城市地区。在 第一阶段，我们将使用群体模型构建，一种系统科学方法，以确定因果路径和其他 社区环境的多个层次的特征，以告知CHHANGE的适应性。在第二阶段，我们 将采用设计思维的原则来调整干预措施，并对结果进行概念测试。在这个阶段 我们还将确定最佳的研究设计特征，以便对由此产生的社区水平进行大规模试验 干预在第3阶段，我们将在一个实验室中对干预措施进行初步测试，包括优化研究设计的各个方面。 匹配社区方法。最终的结果将是采取干预措施，减少交叉艾滋病毒，PrEP/PEP， 在种族主义背景下测试污名和仇视同性恋现象，以及测试干预措施所需的规划， 严格的规模设计研究结果将填补预防科学证据库中围绕干预措施的空白， 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。