Adapting a mobile HIV prevention app to increase uptake of HIV and STI testing among rural men who have sex with men

摘要 在美国南部农村的男男性行为者(MSM)中，HIV/STI检测的接受率很低。 然而，艾滋病毒/性传播感染检测是获得预防服务的基本途径，例如接触前预防。 (准备)，和治疗规定。因此，至关重要的是，我们必须找出增加艾滋病毒/性传播感染的方法。 在艾滋病毒和性传播感染发病率方面受到不成比例影响的人群中进行检测。因为. 在艾滋病毒和性传播感染之间的传播和获得风险方面的生物协同作用，这是针对两者的计划 艾滋病毒和性传播感染将比#年治疗这些感染的方案产生更大的流行病学影响。 与世隔绝。我们建议将现有的、有效的艾滋病毒预防应用HealthMindr应用于农村地区的男男性接触者 解决这一群体特有的问题，如遭受耻辱的经历增加和接触机会减少 有文化能力的关怀。然后，我们将测试经过调整的HealthMindr应用程序在增加对 对南方农村男男性接触者进行了超过24个月的艾滋病毒/性传播感染检测。该应用程序将包括组件 用于自我管理的风险评估，制定和支持经常进行艾滋病毒/性传播感染检测的计划，以及 能够在家中订购艾滋病毒/性传播感染自检试剂盒。之前基于APP的艾滋病毒预防试验提供了自我 免费检测试剂盒。如果男性在网上可以买到自检工具，那么他们是否会使用这些工具还是个未知数。 充电。此外，尽管有免费的艾滋病毒/性传播感染自检试剂盒可用，但仍有很大比例的男性没有 完成艾滋病毒检测和更少的完整的性传播感染检测。因此，我们将评估两种不同的 2x2析因试验设计中HIV/STI感染的干预成分：订购HIV/STI自检试剂盒的成本 通过应用程序(免费与自费)和激励性访谈来增强现有应用程序的内容和 提高自我效能感，以制定并执行测试计划。所有参与者都将收到新的 MyHealth应用程序，在HealthMindr应用程序的基础上为农村MSM重新开发。控制臂(臂1)的人将拥有 获得自费艾滋病毒/性传播感染自检试剂盒，不会接受励志面试，手臂2的男性将拥有 获得自费艾滋病毒/性传播感染自检试剂盒，并将接受励志面试，手臂3的男性将拥有 获得免费的艾滋病毒/性传播感染自检试剂盒，不会接受励志访谈，而手臂4的男性将拥有 获得免费的艾滋病毒/性传播感染自检试剂盒和励志访谈。这项研究设计将使我们能够 观察HIV/STI自检试剂盒成本和激励性访谈的主要影响，以及 两种干预措施之间的相互作用，对艾滋病毒/性传播感染检测的吸收超过24个月的随访。

Abstract Uptake of HIV/STI testing among men who have sex with men (MSM) in the rural southern US is low. However, HIV/STI testing is a fundamental gateway to preventive services, such as pre-exposure prophylaxis (PrEP), and treatment provision. Thus, it is critical that we identify methods to increase uptake of HIV/STI testing among this population that is disproportionately affected in terms of HIV and STI incidence. Because of the biological synergy in transmission and acquisition risk between HIV and STIs, programs that target both HIV and STIs will have a greater epidemiological impact compared to programs that treat these infections in isolation. We propose to adapt an existing, efficacious HIV prevention app, HealthMindr, for MSM in rural areas to address issues specific to this population such as increased experiences of stigma and reduced access to culturally competent care. We will then test the efficacy of the adapted HealthMindr app to increase uptake of HIV/STI testing over 24 months of follow-up among MSM in the rural South. The app will include components for self-administered risk assessments, developing and supporting a plan for frequent HIV/STI testing, and the ability to order HIV/STI at-home self-test kits. Previous trials of app-based HIV prevention have provided self- test kits free of charge. It is an open question whether men would use self-test kits if they were available at a charge. Additionally, despite the availability of free HIV/STI self-test kits, large proportions of men still do not complete HIV tests and even fewer complete STI tests. Thus, we will evaluate the effect of two different intervention components on HIV/STI uptake in a 2x2 factorial trial design: cost of HIV/STI self-test kits ordered through the app (free versus self-pay) and a motivational interview to enhance the existing app content and increase self-efficacy to develop and follow through with a testing plan. All participants will receive the new MyHealth app, redeveloped from the HealthMindr app for rural MSM. Men in the control arm (Arm 1) will have access to self-pay HIV/STI self-test kits and will not receive a motivational interview, men in Arm 2 will have access to self-pay HIV/STI self-test kits and will receive a motivational interview, men in Arm 3 will have access to free HIV/STI self-test kits and will not receive an motivational interview, and men in Arm 4 will have access to both free HIV/STI self-test kits and a motivational interview. This study design will allow us to observe the main effects of the cost of HIV/STI self-test kits and the motivational interview, as well as the interaction between the two interventions, on HIV/STI testing uptake over 24 months of follow up.