Addressing Latino MSM Health Disparities by Increasing Engagement with Behavioral and HIV-Prevention Services: An Implementation Science Approach

通过增加行为和艾滋病毒预防服务的参与来解决拉丁裔男男性行为者的健康差异：一种实施科学方法

• 批准号: 10376352
• 负责人: Audrey Harkness
• 金额: $ 31.41万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10376352
• 关键词: AIDS prevention; Address; Age; Area; Automobile Driving; Behavioral; Bisexual; Caring; Clinical; Communities; Community Outreach; Data; Diagnosis; Education; Ensure; Epidemic; Face; Feedback; Financial Hardship; Focus Groups; Foundations; Funding; Gays; Goals; HIV; HIV prevention trial; HIV risk; Health; Health Services; Health system; Human immunodeficiency virus test; Immigrant community; Immigration; Incidence; Individual; Intervention; Interview; Knowledge; Latino; Latino Population; Learning; Mental Health; Mentors; Mentorship; Motivation; National Institute on Minority Health and Health Disparities; Not Hispanic or Latino; Outcome; Pamphlets; Participant; Phase; Population; Positioning Attribute; Postdoctoral Fellow; Privatization; Problem Solving; Process; Professional counselor; Public Health; Qualitative Research; Randomized; Reduce health disparities; Reporting; Research; Research Activity; Research Infrastructure; Research Training; Resources; Science; Scientific Advances and Accomplishments; Services; Sex Orientation; Sexual Health; Site; Solid; Stress; Suggestion; Surveys; Techniques; Time; Training; Trust; Work; behavior change; behavioral health; career; community partnership; cost; design; disparity reduction; effectiveness implementation study; effectiveness implementation trial; ethnic identity; evidence base; feasibility testing; health assessment; health disparity; health equity; health service use; implementation determinants; implementation efforts; implementation evaluation; implementation outcomes; implementation research; implementation science; implementation strategy; informant; men; men who have sex with men; motivational enhancement therapy; outreach; peer; pilot test; pilot trial; pre-exposure prophylaxis; prevention service; psychological distress; racial and ethnic; recruit; scale up; skills; social stigma; substance use; syndemic; trial comparing; uptake

PROJECT SUMMARY Miami is an HIV hotspot, driven by HIV disparities among Latino men who have sex with men (MSM). Behavioral health problems (e.g., mental health, substance use) contribute to HIV acquisition, forming synergistic disparities. Yet, Latino MSM show delayed HIV testing and underutilize pre-exposure prophylaxis (PrEP) and behavioral health services, highlighting that existing implementation efforts inadequately reach this population. My preliminary data highlight multilevel, modifiable mechanisms that drive disparities in Latino MSM’s use of PrEP, HIV testing, and behavioral health services. To advance health disparities science and achieve the Ending the HIV Epidemic goals, tailored implementation strategies that address these mechanisms to ensure the equitable delivery of PrEP, HIV testing, and behavioral health services to Latino MSM must be developed and evaluated. Research Strategy. Aim 1: Discover the key components of a culturally tailored implementation strategy that addresses the mechanisms driving Latino MSM disparities in HIV-prevention and behavioral health service use. I will leverage my preliminary data to develop a culturally tailored implementation strategy, Dime Más (“Tell Me More”) with the goal of ensuring the equitable delivery of PrEP, HIV testing, and behavioral health services to Latino MSM. From my prior work, I anticipate Dime Más will involve Latino MSM outreach workers using techniques such as motivational interviewing, problem solving, and destigmatizing narratives to engage Latino MSM in services. Results of three phases of formative research (focus groups, demonstration and feedback sessions, and a feasibility test) will be used to iteratively refine Dime Más. Aim 2: Evaluate the impact of the culturally tailored implementation strategy on Latino MSM disparities in service use. I will then conduct a pilot trial comparing Dime Más delivered by a Latino MSM outreach worker from our community partner site to standard community outreach only. Latino MSM will be randomized 1:1 to each condition (N=60, ~50% U.S. born). The trial will evaluate the impact of Dime Más on health disparities by examining PrEP, HIV testing, and behavioral health uptake across groups and exploring mechanisms of effects. We will also examine implementation outcomes (appropriateness, acceptability, feasibility, fidelity, cost) via exit interviews and surveys with participants and outreach workers. Outcomes. The proposed research and the associated training and mentoring activities will begin to elucidate the tailored strategies needed to overcome factors driving Latino MSM’s HIV and behavioral health disparities, while also building my expertise in using implementation research to advance health disparities science. With expert mentors, a strong HIV research infrastructure, solid community partnerships, and the urgent public health need to scale up PrEP, HIV testing, and behavioral health services to Latino MSM, I am well positioned to advance my research and training plan.The findings will lay the foundation for a subsequent R01 hybrid effectiveness- implementation trial, further advancing health disparities science and health equity for Latino MSM.

项目总结 迈阿密是艾滋病毒高发区，原因是男男性行为者(MSM)中拉丁裔男子之间的艾滋病毒差异。 行为健康问题(例如，精神健康、药物使用)有助于艾滋病毒的感染、形成 协同效应差异。然而，拉丁裔男男性接触者表现出艾滋病毒检测的延迟和接触前预防措施的不足 (PREP)和行为健康服务，强调现有的实施努力不足以达到这一目标 人口。我的初步数据突出了多层次的、可修改的机制，这些机制导致了拉丁裔的差异 男男性接触者对PrEP、HIV检测和行为健康服务的使用情况。促进健康差距的科学和 实现结束艾滋病毒流行的目标，制定针对这些机制的执行战略 为了确保公平地向拉丁裔MSM提供PrEP、艾滋病毒检测和行为健康服务，必须 开发和评估。研究策略。目标1：发现文化定制的关键组成部分 实施战略，解决导致拉丁裔MSM在艾滋病毒预防和预防方面存在差异的机制 行为健康服务使用情况。我将利用我的初步数据来开发一种文化定制的 执行战略，DIME MáS(“告诉我更多”)，其目标是确保公平地提供初级教育方案， 艾滋病毒检测，以及为拉丁裔MSM提供行为健康服务。从我之前的工作来看，我预计马云·S将 让拉丁裔MSM外展工作者参与，使用励志访谈、解决问题、 以及将叙事去污名化，以吸引拉丁裔MSM参与服务。形成性研究三个阶段的成果 (焦点小组、演示和反馈会议以及可行性测试)将用于反复改进 目标2：评估文化定制实施战略对拉丁裔MSM的影响 服务使用方面的差距。然后我将进行一项试点试验，比较一名拉丁裔MSM接生的一角钱MáS 外展工作人员从我们的社区合作伙伴网站到标准的社区外展。拉丁裔MSM将是 每种情况随机1：1(N=60，~50%在美国出生)。审判将评估一丁点马菲对S的影响 通过检查PrEP、艾滋病毒检测和跨组行为健康吸收来实现健康差异，并探索 作用机制。我们还将审查执行成果(适当性、可接受性、 可行性、保真度、成本)，通过对参与者和外展工作人员的离职访谈和调查。结果。这个 拟议的研究以及相关的培训和指导活动将开始阐明量身定制的 需要克服导致拉丁裔MSM艾滋病毒和行为健康差异的因素的战略，同时还 建立我的专业知识，利用实施研究来推进健康差距科学。与专家合作 导师，强大的艾滋病毒研究基础设施，稳固的社区伙伴关系，以及紧迫的公共卫生需求 为了将PrEP、HIV检测和行为健康服务扩展到拉丁裔MSM，我已经做好了充分的准备 我的研究和培训计划。这些发现将为后续的R01混合有效性奠定基础- 实施试验，进一步推进拉丁裔男男性接触者健康差距科学和健康公平。