PrEP Initiation and Adherence among Black SMM: A Social Network-Level Intervention

项目摘要 背景黑人男性的社交网络，包括黑人同性恋、双性恋和其他黑人性行为者。 少数民族男性（SMM），影响他们的决策和艾滋病毒相关的行为（例如，使用避孕套，艾滋病毒 测试）。社交网络战略干预措施在增加艾滋病毒检测方面取得了成功 在华盛顿，华盛顿特区从未接受过检测且HIV状态未知的黑人SMM中（McCree et 例如，2013; Baytop等人，2014）。最近在华盛顿的黑人SMM中进行的一项差异有效性研究 （在Us Helping Us进行）证明SNS优于场地测试和合作伙伴服务， 招募从未接受过测试的男性（Baytop等人，2014）。SNS干预也规避了结构性 暴露前预防（PrEP）的障碍，如耻辱，歧视和医疗不信任。拟议 研究的目的是设计和开放阶段试点低强度，成本效益的SNS干预，以增加PrEP 在黑人SMM中开始。这是至关重要的，因为黑人SMM在美国的艾滋病发病率最高。 根据目前的艾滋病毒预防，治疗和护理率，50%的黑人SMM将在他们的 与约10%的白色SMM和25%的拉丁裔SMM相比， 美国公共卫生系统的失败。因此，有针对性的艾滋病毒预防和基于社会网络的 干预措施，如SNS，是必要的，以满足黑色SMM的独特需求。 项目概述。前12个月（第1阶段：形成性研究）将是一个干预 发展/适应阶段。使用基于社区的参与性方法（n = 18岁-PrEP使用 针对具体情况的焦点小组，每个小组至少有4 - 5名参与者，共计72 - 90人），参与者将被问及 社交网络动态和特征（例如，有影响力的网络成员，关于PrEP的沟通 作为一种艾滋病毒预防方法），影响他们决定启动PrEP。在没有PrEP的参与者中， 使用，他们将被问及与PrEP交谈的可接受性和可行性，使用黑色SMM在他们的 相应的社交网络，以支持启动沿着与相关PrEP相关信息的偏好， 同龄人接下来的12个月（第2阶段：开放阶段试点研究）将涉及进行开放试点， SNS干预，最多6批，最多5名参与者（n = 30），允许进一步干预 精致。这将使我们能够证明参与者的可行性和接受度，其中包括以下能力： 招募网络成员，干预措施的可行性，以及参与者行为的变化。它将允许 进一步评估所有研究程序的可行性，完善干预手册，并提供 试点数据提交NIH申请进行更大规模的前瞻性试验。因此，预期的结果是 文化相关的SNS干预，通过使用PrEP的社交媒体增加黑人SMM中的PrEP启动 网络成员。

PROJECT SUMMARY Background. The social networks of Black men, including Black gay, bisexual and other Black sexual minority men (SMM), influence their decision-making and HIV-related behaviors (e.g., condom use, HIV testing). Social networking strategies (SNS) interventions have been successful at increasing HIV testing among Black SMM who had never been tested and with unknown HIV status in Washington, D.C. (McCree et al., 2013; Baytop et al., 2014). A recent differential effectiveness study among Black SMM in Washington, DC (conducted at Us Helping Us) demonstrated SNS to be superior to venue testing and partner services in recruiting men that had never been tested (Baytop et al., 2014). SNS interventions also circumvent structural barriers to pre-exposure prophylaxis (PrEP) such as stigma, discrimination and medical mistrust. The proposed study aims are to design and open-phase pilot a low-intensity, cost-effective SNS intervention to increase PrEP initiation among Black SMM. This is critical because Black SMM have the highest HIV incidence in the U.S. and based on current HIV prevention, treatment and care rates, 50% of Black SMM will acquire HIV in their lifetime compared with ~10% of White SMM and 25% of Latino SMM Importantly, this highlights a critical failure of the U.S. public health system. Therefore, focused HIV prevention and social network-based intervention efforts, such as SNS, are warranted to meet the unique needs of Black SMM. Overview of project. The first 12 months (Phase 1: Formative Research) will be an intervention development/adaptation phase. Using a community-based participatory approach (n=18 age- and PrEP use profile-specific focus groups, of at least 4-5 participants each, totaling 72-90), participants will be asked about the social network dynamics and characteristics (e.g., influential network members, communication about PrEP as an HIV prevention method) that influenced their decision to initiate PrEP. Among participants with no PrEP use, they will be asked about the acceptability and feasibility of talking with PrEP-using Black SMM within their respective social network to support initiation along with preferences for relevant PrEP-related information from peers. The following 12 months (Phase 2: Open-phase Pilot Study) will involve conducting an open pilot of the SNS intervention, in up to six batches of up to 5 participants (n=30), allowing for further intervention refinement. This will allow us to demonstrate participant feasibility and acceptance, which includes the ability to recruit network members, feasibility of intervention delivery, and changes in participant behaviors. It will allow for further evaluation of the feasibility of all study procedures, refinement of intervention manual, and provide pilot data to submit an NIH application for a larger prospective trial. Therefore, the expected outcome is a culturally relevant SNS intervention to increase PrEP initiation among Black SMM through PrEP-using social network members.