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

摘要：男男性行为者(YBMSM)的年轻黑人男性感染了新的HIV病毒 美国的诊断。人们普遍认为，预防艾滋病的干预措施，如PrEP是有效的， 但是，在YBMSM中成功实施PrEP受到几个结构性因素的限制 订婚。确定HIV阴性(YBMSM-)的地方，他们感染HIV的风险增加，但不是 PREP可以为基督教青壮年男男性接触者提供以场所为基础的艾滋病毒预防策略。一项新的研究表明， 基于地点的联系网络，人们通过访问相同的地点与其他人联系 塑造个人的吸毒和性行为。然而，关于基于地点的从属关系是如何存在的，人们知之甚少 网络与PrEP等生物行为干预措施的吸收有关。这项提案将确定 YBMSM-感染艾滋病毒风险增加但尚未接受PrEP治疗的常规场所。减少 在干预目标上的冗余，我们将优先考虑与其他经常光顾的地方的高连通性 参加预科考试的人。此外，GPS和测量数据之间的互连使 研究人员了解卫生保健参与者参与行为的社会规范 同一个地方(S)，但可能认识也可能不认识，这可以指导一个更好的设计 与背景相关的干预。然而，关于基于地点的从属关系网络的工作却很少 和YBMSM对PrEP的准备情况，现有的研究大多依赖于带有自我报告的调查数据 关于经常光顾的地方的数据。使用全球定位系统(GPS)技术可以提供实时和 目的了解青壮年男男性接触者参加的地点，减少测量的偏颇和不准确。这 该提案旨在利用GPS数据来识别：1)基督教青年会参加的固定地点；2)地点对地点的从属关系 由两个或两个以上个人共同出席(S)形成的网络；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)。我们将进行二次数据 来自芝加哥正在进行的393名YBMSM社区和网络(N2)队列研究的分析。 参与者完成了为期两周的GPS方案和关于他们PrEP使用、药物使用、性行为、 和社交/性爱网络。还收集了电子健康记录数据以评估PrEP临床 订婚。拟议研究的具体目标是：目标1)识别和确定空间- YBMSM经常光顾的常规场所的时间分布。目标2)构建和表征 动态地点到地点考勤网络。目的3)确定参加该活动的艾滋病毒阴性青年男同性恋者 同一地区(S)有相似的性行为和吸毒行为，HIV阳性网络百分比和对PrEP的接受率。这 研究将演示基于地点的从属关系方法如何(1)提供信息并最大限度地利用地点 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 展示同一地点参加人员的保健参与行为(S)。

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).