Harnessing the power of peer navigation and mHealth to reduce health disparities in Appalachia

阿巴拉契亚是美国社会和经济上处于不利地位的地区，越来越多的证据表明， 表明阿巴拉契亚和美国其他地区的健康差距正在扩大。同性恋双性恋 在阿巴拉契亚农村， 艾滋病毒、性传播感染（STI）和丙型肝炎病毒（HCV）的风险。仍然缺乏 采取有效办法，解决GBMSM和 生活在美国农村的变性妇女。 在目标1中，我们的社区参与式研究（CBPR）伙伴关系建议系统地 整合两个循证战略（即，同行导航和移动健康），以全面的文化 一致的双语干预，以增加所需的艾滋病毒，性传播感染和丙型肝炎预防和护理的使用 在阿巴拉契亚农村地区的种族/民族多样化的GBMSM和变性妇女中提供服务。在目标2中， 将实施和测试干预，通过纵向组随机设计，使用行为 在以下时间点收集评估和深入访谈数据：（1）基线，（2）干预后即刻，和（3）12- 月随访。我们的假设是，干预组的参与者，相对于他们的同行， 延迟干预组，将证明（1）增加艾滋病毒，性传播感染，和丙型肝炎病毒检测和（2）增加 使用所需的预防服务（PrEP和注射器服务）和护理服务（艾滋病毒护理、性传播感染和丙型肝炎） 治疗和性别肯定护理）。在目标3中，我们将发展和传播实践，研究， 干预措施、政策优先事项和建议，以减少阿巴拉契亚农村地区的健康差距， 举办以增强权能理论为基础的社区论坛。 这项CBPR研究将通过测试创新的方法来推进预防科学和实践 采取干预措施，促进和支持使用所需的艾滋病毒、性传播感染和丙肝预防和护理服务 以及制定优先事项和建议， 这些信息将被传播，以告知公共卫生实践、研究和政策。通过集成对等 导航和移动健康战略，拟议的研究提供了一个独特的机会，以改善健康 生活在阿巴拉契亚农村的弱势、隐蔽和被忽视的人群。这项研究的结果可能 为解决其他农村人口的其他健康差距提供信息战略和方法。

Appalachia is a socially and economically disadvantaged part of the US, and growing evidence suggests that health disparities between Appalachia and the rest of the country are widening. Gay, bisexual, and other men who have sex with men (GBMSM) and transgender women in rural Appalachia are at increased risk for HIV, sexually transmitted infections (STIs), and hepatitis C virus (HCV). There remains a dearth of effective approaches to address these emerging and intersecting epidemics among GBMSM and transgender women living in rural settings in the US. In Aim 1, our community-based participatory research (CBPR) partnership proposes to systematically integrate two evidenced-based strategies (i.e., peer navigation and mHealth) into a comprehensive culturally congruent, bilingual intervention to increase the use of needed HIV, STI, and HCV prevention and care services among racially/ethnically diverse GBMSM and transgender women in rural Appalachia. In Aim 2, we will implement and test the intervention through a longitudinal group-randomized design using behavioral assessment and in-depth interview data collected at: (1) baseline, (2) immediate post intervention, and (3) 12- month follow-up. Our hypotheses are that participants in the intervention group, relative to their counterparts in the delayed-intervention group, will demonstrate (1) increased HIV, STI, and HCV testing and (2) increased use of needed prevention services (PrEP and syringe services) and care services (HIV care, STI and HCV treatment, and gender-affirming care). In Aim 3, we will develop and disseminate practice, research, intervention, and policy priorities and recommendations to reduce health disparities in rural Appalachia by conducting an empowerment theory-based community forum. This CBPR study will advance prevention science and practice through testing an innovative intervention to promote and support the use of needed HIV, STI, and HCV prevention and care services among GBMSM and transgender women; and developing priorities and recommendations to improve their health that will be disseminated to inform public health practice, research, and policy. By integrating peer navigation and mHealth strategies, the proposed study provides a unique opportunity to improve health among vulnerable, hidden, and neglected populations living in rural Appalachia. Findings from this research may inform strategies and approaches to address other health disparities in other rural populations.