Development and Feasibility Testing of a Multi-Component Intervention to Increase HIV Testing and Linkage to Services among MSM in Peru

多成分干预措施的开发和可行性测试，以加强秘鲁男男性行为者之间的艾滋病毒检测和服务联系

• 批准号: 10450045
• 负责人: Alexander Julian Lankowski
• 金额: $ 18.7万
• 依托单位: FRED HUTCHINSON CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10450045
• 关键词: AIDS prevention; Address; Adherence; Alcohol consumption; Area; Attitude; Automation; Automobile Driving; Caring; Clinic; Clinical Research; Communities; Complement; Consolidated Framework for Implementation Research; Continuity of Patient Care; Development; Development Plans; Diagnosis; Elements; Exposure to; Focus Groups; Goals; HIV; HIV Infections; HIV Seronegativity; HIV diagnosis; Health Personnel; Health Services Accessibility; Home; Hour; Human immunodeficiency virus test; Incidence; Individual; Institution; International; Intervention; Intervention Trial; Interview; Language; Link; Logistics; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Multimedia; Nature; Newly Diagnosed; Outcome; Output; Participant; Peru; Population; Positioning Attribute; Prevention; Privacy; Provider; Quantitative Evaluations; Research; Research Personnel; Resources; Risk; Sauna; Scheme; Security; Services; Site; Standardization; Structure; Target Populations; Technology; Testing; Text; Time; Training; Vulnerable Populations; Work; antiretroviral therapy; barrier to care; base; career; career development; comparative; cost; digital; evidence base; experience; feasibility testing; feasibility trial; field study; implementation barriers; implementation facilitators; implementation science; improved; mHealth; men who have sex with men; multi-component intervention; multidisciplinary; novel; outreach; point of care testing; pre-exposure prophylaxis; preference; prevention service; primary outcome; recruit; scale up; secondary outcome; self testing; service intervention; sex; sexual risk behavior; social; theories; therapy development; transmission process; treatment services; two way texting; uptake; usability; user-friendly; web portal

SUMMARY/ABSTRACT Despite the scale-up of free antiretroviral treatment (ART), HIV incidence among men who have sex with men (MSM) in Perú remains high. Delayed diagnosis and suboptimal linkage to care are two important factors driving onward transmission. New strategies to increase rates of testing and promote timely linkage to HIV treatment and prevention are greatly needed. Venue-based testing and mobile health (mHealth) are two promising strategies that could address these challenges by mitigating key barriers to care experienced by MSM in Perú. Based on our previous work, offering HIV testing at social venues (e.g. bars/discos, public plazas) in Lima is acceptable and identifies MSM with previously undiagnosed HIV infection. Extending this to sex-on-premises venues (SOPVs: saunas, sex clubs, hourly hotels) could reach a particularly vulnerable sub-population of MSM, including those not reached by clinic-based testing. One potential pitfall of venue-based HIV testing is low linkage to care among newly diagnosed HIV+ individuals. WelTel is an evidence-based mHealth platform that may be well-suited to assist by adapting its theory-guided two-way messaging approach to support linkage to care – and prevention – among MSM reached for HIV testing at SOPVs. In this proposal we will develop, refine, and conduct feasibility testing of a multi-component HIV testing and linkage-to-services intervention for MSM in Perú, consisting of two core components: 1) SOPV-based HIV testing and 2) “AppSalud”, a novel tailored application of WelTel to facilitate linkage to HIV services. In AIM 1, we will conduct formative research with the target population and key stakeholders to guide development of the intervention. In AIM 2, we will develop AppSalud by reconfiguring WelTel with new tailored content, then beta test it with both potential user types: (a) MSM, and (b) providers at HIV clinics in Lima (to test the provider interface). Guided by the “mCFIR”, a mHealth- specific version of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed methods analysis exploring potential implementation barriers and facilitators for AppSalud from the perspectives of both MSM and providers. In AIM 3, we will conduct a feasibility trial of the multi-component intervention (SOPV- based HIV testing plus AppSalud), comparing 3 HIV testing formats: rapid point-of-care testing (POCT), home based self-testing (HBST), and referral for clinic-based testing (RCBT). Supported by a team of experienced international HIV investigators and outstanding institutions in both the U.S. and Perú, these studies constitute the mentored clinical research component of the candidate’s career development plan. In parallel with this research, the candidate will pursue additional training in implementation science, qualitative/mixed methods, mHealth, and intervention trials, guided by a multidisciplinary team of committed mentors with expertise in each of these areas. The training and mentored research made possible by this K23 Award will launch the candidate’s career as an independent investigator poised to achieve his long-term goal of becoming a leading HIV researcher developing evidence-based strategies to optimize HIV prevention and care globally.

摘要/摘要 尽管免费抗逆转录病毒治疗(ART)的规模扩大，但男男性行为者中艾滋病毒的发病率 Perú的男男性接触者(MSM)仍然很高。延误的诊断和次优的护理联系是推动 继续传输。提高检测率和促进及时与艾滋病毒治疗挂钩的新战略 和预防是非常必要的。基于场地的测试和移动健康(MHealth)是两个很有前途的 可通过减轻Perú男男性接触者在护理方面遇到的主要障碍来应对这些挑战的战略。 根据我们之前的工作，在利马的社交场所(如酒吧/迪斯科舞厅、公共广场)提供艾滋病毒检测是 可以接受，并确认男男性接触者患有以前未诊断出的艾滋病毒感染。将这一点扩展到场所性行为 场所(SOV：桑拿房、性爱俱乐部、小时旅馆)可以接触到特别脆弱的MSM亚人群， 包括那些不能通过临床检测达到的目标。以场地为基础的艾滋病毒检测的一个潜在陷阱是低联动性 在新诊断的HIV+患者中提供护理。Weltel是一个基于证据的移动健康平台，它可能 通过调整其理论指导的双向消息传递方法来支持与护理的联系，非常适合提供帮助-以及 预防--在SOPV接受艾滋病毒检测的男男性接触者中。在本提案中，我们将开发、完善和 对男男性行为者进行多成分艾滋病毒检测和服务联动干预的可行性测试 在Perú，由两个核心组成部分组成：1)基于SOPV的艾滋病毒检测和2)“AppSalud”，一个新的定制 应用Weltel促进与艾滋病毒服务的联系。在目标1中，我们将与 以目标人群和关键利益相关者为指导开展干预工作。在AIM 2中，我们将开发 AppSalud通过使用新的定制内容重新配置Weltel，然后使用两种潜在用户类型进行Beta测试：(A) (B)利马艾滋病毒诊所的提供者(以测试提供者接口)。在mCFIR的指导下，一家mHealth- 具体版本的实施研究综合框架(CFIR)，我们将进行混合 方法分析从角度探索AppSalud潜在的实施障碍和促进者 无论是MSM还是供应商。在目标3中，我们将进行多成分干预的可行性试验。 基于HIV检测加上AppSalud)，比较了3种HIV检测方式：快速护理点检测(POCT)、家庭 基于自我测试(HBST)和基于临床测试的推荐(RCBT)。由一支经验丰富的 国际艾滋病毒调查人员和美国和Perú的杰出机构，这些研究构成 候选人职业发展计划中受指导的临床研究部分。与此并行的是 研究，应聘者将在实施科学、定性/混合方法、 MHealth和干预试验，由具有以下专业知识的多学科导师组成的团队指导 这些领域中的每一个。这项K23奖所提供的培训和指导研究将推出 候选人作为一名独立调查员的职业生涯准备实现他成为领先的 艾滋病毒研究人员正在制定循证战略，以优化全球艾滋病毒预防和护理。