Estimating the Impact of a Multilevel, Multicomponent Intervention to Increase Uptake of HIV Testing and Biomedical HIV Prevention among African?American/Black Gay, Bisexual and Same-gender Loving Men

摘要 增加对生物医学预防(PEP/PrEP)的获得和接受对于在世界各地结束这一流行病至关重要 美国(美国)同性恋、双性恋和其他与其他男性发生性关系的男性(MSM)。这是特别的 对于城市、非裔美国人或黑人MSM来说是这样的，他们受艾滋病毒的影响不成比例，因此 受益于更多的艾滋病毒检测，现在建议关键群体每3-6个月进行一次艾滋病毒检测，这是 到治疗和预防。纽约市是美国新确诊病例最多的大都市 MSM中的艾滋病毒感染和美国89-94%的艾滋病毒/艾滋病感染者(PLWHA)居住在城市 区域。尽管这样的城市地区通常有强有力的测试和PEP/PrEP传播计划，但一致 在城市居住的黑人MSM中，检测和PEP/PrEP摄取率低得令人无法接受。因此，有必要 通过加速现有实施和实施来支持艾滋病毒检测和PEP/PrEP吸收的干预措施 传播努力。大多数艾滋病毒检测和PEP/PrEP摄取干预措施侧重于个人层面的导航 系统/结构障碍和/或认知因素(意图、动机、技能)对行为的影响；很少关注 关于通过自我测试、赋权、同行减少与耻辱/歧视有关的测试/PEP/PrEP障碍 支持和社区规范。为了填补这一空白，我们建议测试一种由循证干预组成的干预措施 以及由我们的研究团队设计的新型干预组件，这些组件在多个层面上运行，可以 纳入CBO提供的艾滋病毒预防方案，以支持艾滋病毒检测和PEP/PrEP吸收。我们 将评估组件的相加和交互影响，包括单会话、基于同行的艾滋病毒 自我测试组件、三会话PEP/PrEP导航增强组件以及社交和打印组件 反交叉污名媒体运动，使用析因设计和准实验设计。初级阶段 结果是艾滋病毒检测(虽然不是PrEP/PEP)和PrEP摄取。次要结果包括一致 艾滋病毒检测(9个月中至少间隔3个月的2+检测)；PEP摄取率；PrEP/PEP依从性(自我报告/医疗 记录/尿液测试)。为了达到研究目标，我们将招募480名符合PrEP资格的黑人MSM(年龄18-55岁)居住在 将他们随机分配到四个研究小组中的一个，并对他们进行18个月的跟踪调查。 我们的研究代表了一个基于社区的组织之间的合作，目前 PEP/PrEP摄取规划和一个学术研究团队，旨在确定 在不同级别运行的组件，旨在增加个人级别的艾滋病毒检测和 在高度易感染艾滋病毒的人群中使用生物医学预防艾滋病毒。

ABSTRACT Increasing access to and uptake of biomedical prevention (PEP/PrEP) is critical to ending the epidemic in the United States (US) among gay, bisexual and other men who have sex with other men (MSM). This is particularly true for urban, African-American or Black MSM, who are disproportionately affected by HIV and would thus benefit from more HIV testing, which is now recommended every 3-6 months for key groups and is the gateway to treatment and prevention. NYC is the metropolitan area in the US with the largest number of newly diagnosed HIV infections among MSM and 89-94% of all people living with HIV/AIDS (PLWHA) in the US reside in urban areas. Although such urban areas often have robust testing and PEP/PrEP dissemination programs, consistent testing and PEP/PrEP uptake is unacceptably low among urban-dwelling Black MSM. There is thus a need for interventions to support both HIV testing and PEP/PrEP uptake by accelerating existing implementation and dissemination efforts. Most HIV testing and PEP/PrEP uptake interventions focus on individual-level navigation of system/structural barriers and/or cognitive antecedents (intentions, motivation, skills) to behavior; few focus on reducing stigma/discrimination-related barriers to testing/PEP/PrEP via self-testing, empowerment, peer support and community norms. To fill this gap, we propose to test an intervention composed of evidence-based and novel intervention components, designed by our study team, that operate at multiple levels and can be integrated into CBO-delivered HIV prevention programming to support HIV testing and PEP/PrEP uptake. We will estimate additive and interactive effects of the components, that include a single-session, peer-based HIV self-testing component, a three-session PEP/PrEP navigation enhancement component, and a social and print anti-intersectional stigma media campaign, using factorial and quasi-experimental designs. The primary outcomes are HIV testing (while not on PrEP/PEP) and PrEP uptake. Secondary outcomes include consistent HIV testing (2+ tests at least 3 months apart in 9 months); PEP uptake; PrEP/PEP adherence (self-report/medical record/urine test). To achieve the study aims, we will enroll 480 PrEP-eligible Black MSM (aged 18-55) living in Central Brooklyn into the study and randomize them to one of four study arms and follow them over 18 months. Our study, which represents a collaboration between a community-based organization currently engaged in PEP/PrEP uptake programming and an academic research team, is designed to identify the added value of components that operate at different levels and are designed to increase individual-level HIV testing and biomedical HIV prevention use among a group highly vulnerable to HIV.