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，男男性行为者（MSM）接受艾滋病毒/性传播感染检测的比例很低。 然而，艾滋病毒/性传播感染检测是获得预防服务，如接触前预防的基本途径 （PrEP）和治疗提供。因此，我们必须确定增加艾滋病毒/性传播感染的方法， 在艾滋病毒和性传播感染发病率受到不成比例影响的这一人群中进行检测。因为 艾滋病毒和性传播感染之间在传播和获得风险方面的生物协同作用， 艾滋病毒和性传播感染将有更大的流行病学的影响相比，治疗这些感染的方案， 隔离我们建议为农村地区的男男性行为者调整现有的有效的艾滋病预防应用程序HealthMindr 解决这一群体特有的问题，如遭受耻辱的经历增加和获得保健服务的机会减少， 文化上的关怀。然后，我们将测试适应HealthMindr应用程序的有效性，以增加对 对南部农村男男性行为者进行为期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 进行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， 能够订购艾滋病毒/性传播感染家庭自测包。以前的基于应用程序的艾滋病毒预防试验提供了自我- 免费提供测试工具包。这是一个悬而未决的问题，如果他们在一个有自我测试工具包， 消费标准.此外，尽管有免费的艾滋病毒/性传播感染自我检测包，但仍有很大一部分男子没有这样做。 完成艾滋病毒检测和更少的完整性传播感染检测。因此，我们将评估两种不同的 2x2析因试验设计中艾滋病毒/性传播感染的干预成分：订购艾滋病毒/性传播感染自测试剂盒的费用 通过应用程序（免费与自费）和激励性访谈，以增强现有的应用程序内容， 提高自我效能，以制定并贯彻测试计划。所有参与者都将收到新的 MyHealth应用程序，从HealthMindr应用程序重新开发的农村男男性接触者。对照组（第1组）的男性 获得自费艾滋病毒/性传播感染自我检测试剂盒，并且不会接受动机性访谈，第2组中的男性将有 获得自费艾滋病毒/性传播感染自测试剂盒，并将接受激励性面谈，第3组的男性将获得 获得免费的艾滋病毒/性传播感染自我检测试剂盒，不会接受动机性访谈，第4组的男性将获得 获得免费的艾滋病毒/性传播感染自我检测包和一次激励性面谈。这项研究设计将使我们能够 观察艾滋病毒/性传播感染自我检测试剂盒和动机性访谈的成本的主要影响，以及 两种干预措施之间的相互作用，在24个月的随访中进行艾滋病毒/性传播感染检测。

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.