PrEP Intervention Models for Young Black MSM: A Place-based Affiliation Network Approach

摘要：男男性行为黑人青年（YBMSM）是新感染艾滋病病毒的主要人群 人们普遍认为，艾滋病毒预防干预措施，如PrEP是有效的， 但在YBMSM中成功实施PrEP受到几个结构性因素的限制， 订婚确定艾滋病毒阴性（YBMSM-）感染艾滋病毒风险增加但未感染艾滋病毒的地方。 PrEP可以为YBMSM中基于场所的艾滋病毒预防策略提供信息。一项新的研究表明， 基于地点的联系网络，其中人们通过访问相同的地点与其他人联系 影响个人的吸毒和性行为然而，很少有人知道基于地点的隶属关系如何 网络与PrEP等生物行为干预措施的吸收相关。该提案将确定 YBMSM-花时间在艾滋病毒风险增加但尚未接受PrEP的定期场所。 为了减少干预目标的冗余，我们将优先考虑与其他经常光顾的地方高度连通的地方， 此外，GPS和调查数据之间的互联性使 研究人员了解参加者之间医疗保健参与行为的社会规范 同一个地方，但可能认识也可能不认识，这可以指导更好的设计， 相关的干预。然而，很少有工作已经进行了基于地点的隶属关系网络 YBMSM中的PrEP准备情况，大多数现有研究依赖于自我报告的调查数据 常去的地方的数据。全球定位系统（GPS）技术的使用可以提供实时和 客观的数据，YBMSM关注的地方，可以减少偏见和不准确的测量。这 一项提案旨在利用GPS数据来确定：1）YBMSM经常参加的地方; 2）地方与地方的联系 由两名或以上人士在同一地方共同出席而形成的网络;及（3）个人对个人 出席网络（即，参加一个或多个共享场所的个人）。我们将进行二级数据 来自芝加哥正在进行的社区和网络（N2）队列研究的393名YBMSM的分析。 参与者完成了为期两周的GPS协议，并对他们的PrEP使用，药物使用，性行为， 社交/性网络还收集电子健康记录数据以评估PrEP临床 订婚本研究的具体目标是：1）识别和确定空间位置; YBMSM经常光顾的固定地点的时间分布。目标2）构建和表征 动态的地点到地点的出勤网络。目的3）确定参加艾滋病毒检测的YBMSM是否为HIV阴性， 同一地区的性行为和吸毒行为、艾滋病毒阳性网络的百分比和PrEP的吸收情况相似。 研究将展示基于地点联系方法如何能够（1）告知和最大化基于地点的联系， 通过确定干预的最佳地点进行干预，以及（2）通过以下方式指导与背景相关的干预： 在同一地点的人群中展示医疗保健参与行为。

ABSTRACT: Young black men who have sex with men (YBMSM) bear a significant burden of new HIV diagnoses in the U.S. It is widely recognized that HIV prevention interventions such as PrEP are efficacious, but successful PrEP implementation among YBMSM is limited by several structural factors that impede engagement. Identifying places where HIV-negative (YBMSM-) who are at increased risk for HIV but not on PrEP can inform place-based HIV prevention strategies among YBMSM. A new line of research indicates the place-based affiliation network wherein people are connected with others through visiting the same places shapes individuals' drug use and sex behaviors. However, little is known about how place-based affiliation networks are associated with uptake of biobehavioral interventions such as PrEP. This proposal will identify regular places where YBMSM- spend time who are at increased risk for HIV, but not yet on PrEP. To reduce redundancy in intervention targets, we will prioritize places with high connectivity to other places frequented by people who are candidates for PrEP. Furthermore, the interconnectivity between GPS and survey data enables researchers to understand the social norms in health care engagement behaviors among people who attend the same place(s) but who may or may not know each other, and this can direct a better design for a contextually relevant intervention. However, little work has been conducted on place-based affiliation networks and PrEP readiness among YBMSM, and most of the existing research relies on survey data with self-report data on places frequented. The use of Global Positioning System (GPS) technology can provide real-time and objective data on which places YBMSM attend and can reduce the biased and inaccurate measurement. This proposal aims to utilize GPS data to identify: 1) regular places that YBMSM- attend; 2) place-to-place affiliation networks formed through co-attendance at a place(s) by two or more individuals; and 3) individual-to-individual attendance networks (i.e., individuals who attend one or more shared places). We will conduct secondary data analysis from an ongoing Neighborhoods and Networks (N2) cohort study in Chicago among 393 YBMSM. Participants completed a two-week GPS protocol and a survey on their PrEP use, drug use, sexual behaviors, and social/sexual network. Electronical Health Record data are also collected to evaluate PrEP clinical engagement. The specific aims for the proposed study are to: Aim 1) Identify and determine the spatio- temporal distribution of regular places commonly frequented by YBMSM. Aim 2) Construct and characterize dynamic place-to-place attendance networks. Aim 3) Determine whether HIV-negative YBMSM who attend the same place(s) have similar sex and drug-using behaviors, % of HIV-positive network, and uptake of PrEP. This study will demonstrate how place-based affiliation approach can (1) inform and maximize place-based intervention by pinpointing optimal places for interventions and (2) direct a contextually relevant intervention by demonstrating health care engagement behaviors among people who attend the same place(s).