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 与男性发生性关系的年轻性和性别少数群体（YSGMSM）承担着不成比例的负担， 艾滋病毒在美国流行，但暴露前预防（PrEP）的吸收和坚持一直是 对这些群体来说，不合适。对艾滋病毒综合症的研究阐明了社会和 HIV风险的结构性因素，但对YSGMSM的HIV综合征的研究仅限于个体 水平测量。一个平行的研究线使用多级模型来显式地建模邻域 然而，迄今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依从性之间的关系。同样，沉浸在数字空间中 (e.g.,社交媒体消费）也会影响艾滋病毒风险。尽管采取了PrEP吸收和 越来越多地通过数字设备提供依从性，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， 日期已经表征了数字沉浸如何通过数字PrEP干预影响PrEP依从性。 最后，已经表明，加入非数字支持团体可以减轻邻里因素， YSGMSM和减少性风险行为表明数字PrEP干预可能具有相同的效果 有能力，但更有影响力。出于这些原因，本研究将探讨如何融合数字和 邻里因素影响PrEP坚持YSGMSM通过利用iTech的P3研究，NICHD资助 随机对照试验（RCT），以改善YSGMSM中的PrEP依从性。这个三臂RCT是 旨在评估P3和P3+改善246名16-24岁青少年PrEP依从性的有效性 美国9家研究中心的YSGMSM。这项研究收集了住宅区的邮政编码， 邻里对PrEP依从性的影响。通过社会和结构邻里的指导培训 YSGMSM中PrEP依从性的决定因素，多水平模型，中介分析，因果推理，以及 专业发展活动，拟议的F31将实现以下具体目标：1）表征 社区综合症风险如何与YSGSM中的PrEP依从性相关，2）确定如何沉浸在数字环境中 P3干预之外的空间和社区影响P3干预之内的参与， 随后的PrEP依从性，3）确定P3干预条件如何减弱关系 社区和数字沉浸因素对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依从性的理解，这是 为YSGMSM提供精确的艾滋病毒预防保健服务。这使NICHD青少年艾滋病毒优先事项保持一致 2030年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.