Neighborhood and digital immersion effects on PrEP adherence through a digital intervention in young sexual and gender minorities who have sex with men

项目摘要 与男性发生性行为的年轻的性和性别少数群体(YSGMSM)对 HIV在美国流行，但暴露前预防(PrEP)的吸收和坚持一直是 对这些群体来说是不够的。对艾滋病毒综合征的研究阐明了社会和社会问题的重要性 HIV风险的结构性因素，然而对YSGMSM的HIV综合征的研究仅限于个人 水平调查措施。一条平行的研究路线使用了多水平模型来明确地对邻域进行建模 然而，到目前为止还没有研究应用这种建模技术来理解直接关系 社会和结构性邻里因素与PrEP遵守之间的关系。同样，沉浸在数字空间中 (例如，使用社交媒体)也会影响艾滋病毒风险。尽管干预了PrEP摄取和 越来越多的坚持通过数字设备提供，其中一些设备利用数字支持 社区和青年中日益增长的数字通信文化，包括YSGMSM，没有研究来 日期已经表征了数字沉浸如何通过数字PrEP干预影响PrEP的遵守。 最后，研究表明，加入非数字支持小组可以缓解社区因素 YSGMSM和减少性危险行为表明数字PrEP干预可能有同样的效果 能力，但覆盖范围更广。出于这些原因，这项研究将考察融合的数字和 利用NICHD资助的ITech的P3研究，社区因素影响YSGMSM对PrEP的遵守 改善YSGMSM患者PrEP依从性的随机对照试验(RCT)。这三臂RCT是 旨在评估P3和P3在246名16-24岁青少年中提高PrEP依从性的有效性 YSGMSM横跨美国九个研究站点。这项研究收集了住宅邮政编码，允许检查 邻里效应对PrEP依从性的影响。通过在社会和结构社区进行辅导培训 YSGMSM中PrEP坚持的决定因素、多水平模型、中介分析、因果推断和 通过专业发展活动，拟议的F31将实现以下具体目标：1)特色化 邻里共性风险如何与YSGSM中遵守PrEP有关，2)确定沉浸在数字环境中的方式 P3‘S干预外的空间和社区影响P3’S干预内的敬业度； 后续的PrEP依从性，3)确定P3干预条件如何削弱这种关系 共相邻域和数字沉浸因素对PrEP依从性的影响。这些目标将 丰富我们对数字和邻里因素如何影响PrEP遵守的理解，这是 为青壮年男男性接触者提供精准的艾滋病预防保健。这使NICHD对青少年艾滋病毒的优先事项保持一致 预防与在2030年前结束美国艾滋病毒流行的倡议。

Project Summary Young sexual and gender minorities who have sex with men (YSGMSM) carry a disproportionate burden of the HIV epidemic in the United States, yet Pre-Exposure Prophylaxis (PrEP) uptake and adherence has been inadequate for these groups. Research into HIV syndemics has illuminated the importance of social and structural factors for HIV risk, yet the research into HIV syndemics for YSGMSM has been limited to individual level survey measures. A parallel line of research has used multilevel models to explicitly model neighborhood factors, however no research to date has applied this modeling technique to understand the direct relationship between social and structural neighborhood factors and PrEP adherence. Similarly, immersion in digital spaces (e.g., consumption of social media) can influence HIV risk as well. Despite interventions for PrEP uptake and adherence being increasingly delivered through digital devices, some of which utilize digital support communities and the growing culture of digital communication among youth, including YSGMSM, no studies to date have characterized how digital immersion influences PrEP adherence through a digital PrEP intervention. Finally, it has been shown that joining non-digital support groups can mitigate neighborhood factors in YSGMSM and reduce sexual risk behaviors suggesting that a digital PrEP intervention might have the same capability but with more reach. For these reasons, this research will examine how convergent digital and neighborhood factors impact PrEP adherence in YSGMSM by leveraging iTech’s P3 study, an NICHD-funded randomized controlled trial (RCT) to improve PrEP adherence among YSGMSM. This three arm RCT is designed to assess the effectiveness of P3 and P3+ to improve PrEP adherence among 246 16-24 year-old YSGMSM across nine US study sites. The study collects residential zip code, allowing for examination of neighborhood effects on PrEP adherence. Through mentored training in social and structural neighborhood determinants of PrEP adherence in YSGMSM, multi-level models, mediation analysis, causal inference, and professional development activities, the proposed F31 will achieve the following specific aims: 1) Characterize how neighborhood syndemic risk relates to PrEP adherence in YSGSM, 2) Identify how immersion in digital spaces and communities outside P3’s intervention influence engagement inside P3’s intervention, and subsequent PrEP adherence, 3) Determine how the P3 intervention condition attenuates the relationship between syndemic neighborhood and digital immersion factors’ impact on PrEP adherence. These aims will enrich our understanding of how digital and neighborhood factors impact PrEP adherence, a critical step in precision preventative health against HIV for YSGMSM. This aligns NICHD priorities for adolescent HIV prevention with the Ending the HIV Epidemic in the US by 2030 Initiative.