Southwest Health Equity Research Collaborative

西南健康公平研究合作组织

• 批准号: 10457777
• 负责人: Julie Ann Baldwin
• 金额: $ 74.98万
• 依托单位: NORTHERN ARIZONA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2022-09-19
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10457777
• 关键词: AIDS prevention; Address; Adoption; Advocate; Age; Age-Years; American Indians; Area; Bisexual; Caring; Cherokee Indian; Chlamydia; Clinic; Communities; Diagnosis; Diagnostic Reagent Kits; Disease; Education; Effectiveness; Epidemic; Evaluation; Familiarity; Focus Groups; Future; Gays; Goals; Gonorrhea; HIV; Health Personnel; Health Services; Health Technology; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Interview; Methods; Oklahoma; Participant; Phase; Prevalence; Prevention; Prevention approach; Primary Prevention; Provider; Randomized; Records; Research; Resources; Rural; Rural Community; Secondary Prevention; Sexually Transmitted Diseases; Surveys; Syphilis; Syphilis Serodiagnosis; Technology; Testing; Training; United States; Universities; Woman; Work; base; condoms; control trial; experience; health equity; informant; mHealth; member; men; men who have sex with men; parent grant; peer; peer coaching; pre-exposure prophylaxis; prevent; prevention service; prototype; recruit; risk perception; rural Americans; rural area; screening; screening services; self testing; sex; sexual HIV transmission; sexual minority; social determinants; social stigma; transmission process; trial design; uptake

PROJECT SUMMARY In the U.S., incidence rates of HIV and sexually transmitted infections (STIs) are disproportionately high among gay, bisexual, and other men who have sex with men—referred to herein as sexual minority men (SMM)— compared to men who have sex with women only.1,2 Roughly 10% of HIV incidence is attributable to increased transmission due to untreated STIs among SMM,3 64% of syphilis cases occur among SMM,4 and SMM residing in Ending the HIV Epidemic (EHE) priority jurisdictions have nearly 50% greater odds of STIs compared to those residing elsewhere.5 Oklahoma is an EHE priority rural state with above average yearly cases of chlamydia and ranks in the top 10 for gonorrhea and syphilis infections nationwide. Within these Oklahoma communities, those under the age of 24 account for a quarter of new HIV, chlamydia, and gonorrhea infections. Less than 28% of rural Oklahomans have received an HIV test during their lifetime and only 5.7% during the past year, the lowest testing rate among the EHE states.6 Similar to their SMM peers, rural American Indian (AI) men have seen an increase in HIV incidence—where the AI men now account for 9.3% of new infections in Oklahoma compared to 7.8% in 2016.7-9 AI men and SMM living in rural areas of the U.S. are less likely to receive HIV prevention messaging, engage in routine testing, identify HIV testing resources, or receive comprehensive education as compared to their urban counterparts. Rural SMM and AI men in Oklahoma experience many barriers to HIV and STI testing, including worries about HIV-related stigma, low perceptions of risk, difficulty communicating with healthcare providers, and confidentiality concerns,10-15 requiring expansion of prevention and screening services. Our proposed research will specifically focus on two EHE pillars: diagnose (i.e., HIV screening) and prevent (i.e., increase condom use; adoption of Pre-Exposure Prophylaxis). Our specific aims are as follows: AIM 1 – To refine our preliminary intervention strategy in partnership with a Community Advisory Board (CAB) and rural peer mentors. In a 4-month formative phase, we will partner with a CAB to finalize Ending the HIV Epidemic in Rural Oklahoma (e-HERO) components to be included in an initial intervention prototype. AIM 2 – To assess feasibility, acceptability, and preliminary impact of the e-HERO intervention. We will pilot and evaluate the finalized intervention in rural Oklahoma using a randomized control trial design to mimic a future statewide implementation. We will recruit rural SMM (n = 100) and AI men (n = 100) between 17-29 years of age. We will use RE-AIM19 to guide the evaluation, which will entail conducting a convergent mixed-method analysis of surveys (SMM and AI men), HIV/STI testing records, and exit interviews to assess feasibility, acceptability, and preliminary impact of the intervention.

项目摘要 在美国，艾滋病毒和性传播感染的发病率高得不成比例， 同性恋、双性恋和其他与男性发生性关系的男性--本文称为性少数男性（SMM）-- 与只与妇女发生性关系的男子相比，1.2大约10%的艾滋病毒发病率可归因于 梅毒感染者中，3.64%的病例发生在SMM、4和SMM中， 居住在终止艾滋病毒流行（EHE）优先管辖区的人患性病的几率高出近50% 俄克拉荷马州是EHE优先的农村州， 衣原体感染病例，在全国淋病和梅毒感染病例中排名前十。在这些 在俄克拉荷马州社区，24岁以下的人占新感染艾滋病毒、衣原体和 淋病感染不到28%的俄克拉荷马州农村人在一生中接受过艾滋病毒检测， 在过去的一年中，只有5.7%，是EHE州中最低的测试率。6与他们的SMM同行类似， 农村的美国印第安人（AI）男性的艾滋病毒感染率有所上升，AI男性现在占 俄克拉荷马州的新感染率为9.3%，而2016年为7.8%。 美国不太可能收到艾滋病毒预防信息，进行常规检测， 与城市居民相比，城市居民拥有更多的资源，或接受更全面的教育。农村SMM和AI 俄克拉荷马州的男性在接受艾滋病毒和性传播感染检测时遇到了许多障碍，包括担心与艾滋病毒有关的耻辱， 风险认知低，难以与医疗保健提供者沟通，以及保密问题，10-15 需要扩大预防和筛查服务。我们建议的研究将具体集中在两个方面 EHE支柱：诊断（即，艾滋病毒筛查）和预防（即，增加避孕套的使用;采用暴露前预防措施 预防）。我们的具体目标如下： 与社区咨询委员会（CAB）和农村同伴导师建立伙伴关系。在为期4个月的成长期 在第一阶段，我们将与CAB合作，最终确定结束俄克拉荷马州农村地区的艾滋病毒流行（e-HERO） 初步干预原型中应包括的组成部分。目的2 -评估可行性、可接受性， 以及e-HERO干预的初步影响。我们将在2010年试行和评估最后确定的干预措施。 农村俄克拉荷马州使用随机对照试验设计，以模拟未来全州范围内的实施。我们将 招募17-29岁的农村SMM（n = 100）和AI男性（n = 100）。我们将使用RE-AIM 19来指导 评估，这将需要进行一个收敛的混合方法分析的调查（SMM和AI 男性）、艾滋病毒/性传播感染检测记录以及离职面谈，以评估可行性、可接受性和初步影响 干预。