CHALO!: A mobile technology based intervention to accelerate HIV testing and linkage to prevention and treatment

背景：尽管有效地预防和治疗艾滋病毒，但全球艾滋病毒流行仍在继续增长。 目前让艾滋病毒高危人群参与的计划效果有限，部分原因是它们没有 接触到风险最高的人群。为了减轻全球艾滋病毒的负担，新的、以证据为基础、影响深远的战略 需要让有风险的人参与艾滋病毒的预防和治疗。在美国和全球，人们都在 越来越多地使用移动/社交技术(SMT)(例如约会应用、WhatsApp、Facebook)进行社交和 结识合作伙伴。虽然这种个人社交方式的转变扰乱了传统的面对面交流，但SMT 提供了一个前所未有的机会，让历史上难以接触到的群体参与进来，例如 男男性行为(MSM)，用于艾滋病毒预防和治疗。这项研究的目标是测试基于SMT的 行为干预，包括免费艾滋病毒检测的数字优惠券(Chalo！2.0)，增强了艾滋病毒检测 以及在印度继续经历高艾滋病毒感染率的人口之间的联系和护理。 这一提议的科学前提是，社区发展的、基于理论的干预将 让在线接触到的艾滋病毒高危男男性行为者参与进来，干预措施将增加艾滋病毒知识 并增强获得艾滋病毒检测的动机和行为技能，并与艾滋病毒预防联系起来(如果艾滋病毒- 未感染)或艾滋病毒治疗(如果感染了艾滋病毒)。这项研究的基本原理是，确定疗效 在广泛传播之前，需要一种可快速扩展的基于SMT的行为干预。这个 这一研究问题的意义在于，即使是适度有效的基于SMT的艾滋病毒预防干预 可以有效地接触到许多艾滋病毒高危人群，并提高对艾滋病毒状况的认识，更好地 与护理挂钩，减少新的艾滋病毒感染。 方法：在一项务实的随机对照试验中，我们将确定Chalo！2.0是否导致 在性行为活跃的男男性接触者中增加艾滋病毒检测和与护理(预防或治疗)的联系 不知道他们的艾滋病毒状况(6个月前从未进行过检测或检测)，而且是在网上招募的。我们将进行一项 一项为期12周的三组随机试验，比较Chalo！2.0和两种对照条件：注意力匹配 基于SMT的控制(还包括免费艾滋病毒检测的数字优惠券)，以及仅限数字优惠券的控制。 潜在影响：尽管全球卫生机构呼吁采取在线干预措施，让人们参与到 没有接触到艾滋病毒高风险人群，几乎没有有效的模式，在印度也不存在，印度是 世界上最大的男男性接触者艾滋病毒流行之一。这项研究将通过测试可扩展和 可复制的在线模式，让艾滋病毒高危人群参与进来，并将他们与艾滋病毒检测和预防或 治疗。该提案是对美国国立卫生研究院PA-18-278号文件的响应：艾滋病毒检测的创新…优化艾滋病毒护理 持续的成果，并涉及国家卫生研究院艾滋病研究办公室的多个高度优先的研究领域。 拟议的模式如果被发现有效，还可能加速实现联合国艾滋病规划署90-90-90护理目标。

Background: Despite effective HIV prevention and treatment, the global HIV epidemic continues to grow. Current programs to engage populations at high HIV risk have had limited impact, in part because they do not reach those at highest risk. To reduce the global burden of HIV, new, evidence-based, far-reaching strategies are needed to engage individuals at risk in HIV prevention and treatment. In the U.S. and globally, people are increasingly using mobile/social technologies (SMT) (e.g. dating apps, WhatsApp, Facebook) to socialize and meet partners. While this shift in how individuals socialize has disrupted traditional face-to-face outreach, SMT provides an unprecedented opportunity to engage historically hard-to-reach groups, such as men who have sex with men (MSM), for HIV prevention and treatment. Th goal of this study is to test whether a SMT-based behavioral intervention that includes a digital coupon for free HIV testing (CHALO! 2.0) enhances HIV testing and linkage-to-care among a population that continues to experience high rates of HIV infection in India. The scientific premise of this proposal is that a community-developed, theory-based intervention will engage MSM at high risk of HIV who are reached online, and that the intervention will increase HIV knowledge and enhance motivation and behavioral skills to obtain HIV testing and get linked to HIV prevention (if HIV- uninfected) or HIV treatment (if HIV-infected). The rationale for this research study is that determining efficacy of a rapidly scalable SMT-based behavioral intervention is needed before widespread dissemination. The significance of this research question is that even a modestly effective SMT-based HIV prevention intervention may efficiently reach many individuals at high risk of HIV and lead to increased HIV status awareness, better linkage-to-care, and fewer new HIV infections. Methods: In a pragmatic randomized controlled trial, we will determine whether CHALO! 2.0 results in increased HIV testing and linkage-to-care (prevention or treatment) among sexually active MSM who are unaware of their HIV status (never tested or tested >6 months ago) and are recruited online. We will conduct a 12-week, three arm randomized trial comparing CHALO! 2.0 to two control conditions: an attention-matched SMT-based control (also including a digital coupon for free HIV testing), and a digital coupon only control. Potential Impact: While global health agencies have called for online interventions to engage populations at high HIV risk who are not being reached, few effective models exist and none exist in India, which is home to one of the world’s largest MSM HIV epidemics. This study will address this gap by testing a scalable and replicable online model to engage individuals at high HIV risk and link them to HIV testing and prevention or treatment. This proposal is responsive to NIH PA-18-278: Innovations in HIV Testing…to Optimize HIV Care Continuum Outcomes, and addresses multiple high priority research areas of NIH’s Office of AIDS Research. The proposed model, if found effective, may also accelerate achieving UNAIDS 90-90-90 care targets.