'REALITY CHECK' IN TRANSIT: Evaluation of a Serial Drama for Black Youth

描述（由申请人提供）：本申请旨在评估加利福尼亚州洛杉矶公共汽车上已经创作的系列戏剧干预，“现实检查”。年轻的非洲裔美国人受到艾滋病毒/艾滋病和其他性传播感染（STIs）的影响非常不成比例。影响其风险的社会因素包括贫穷、难以获得预防性医疗服务和恐同症，这导致一些男男性行为者对这些活动保密，不愿接受艾滋病毒检测。不幸的是，许多感染了艾滋病毒的人并不知道自己受到了感染，而且可能正在传播艾滋病毒，特别是在传染性很强的急性感染阶段。另一方面，那些测试呈阳性的人大大减少了与风险相关的行为。因此，美国疾病控制与预防中心建议普遍进行艾滋病毒检测，尤其是在高危人群中进行检测。因此，这项申请的广泛和长期目标是增加年轻非洲裔美国人的艾滋病毒检测。它建议在洛杉矶贫困的非裔美国人社区中，对乘坐公共汽车的14至24岁的非裔美国人进行一项创新的、基于理论的减少艾滋病毒风险的系列戏剧干预“现实检查”的效果进行试点测试。“现实检查”是在公交乘客的自然环境中实施的结构性干预。它由27集组成，每集3分钟。每集将在1周内每周二、四、五、六每小时播放一次，在洛杉矶所有装有视频屏幕的公交车上播放。之前播出的剧集将在Transit TV网站的YouTube链接上播出。该研究将采用准实验控制组设计，进行干预前和干预后多重评估。加州里士满贫困的非裔美国人社区的公共汽车乘客将作为对照。对14-24岁的非裔美国年轻人进行横断面匿名公交车站调查，这些年轻人每周至少三次乘坐公交经过两个城市的指定贫困地区，并在这些地区居住。调查将在《现实核查》在洛杉矶上映之前、上映后立即、以及上映后3个月和6个月进行。研究样本将包括200名青年，他们分别在这两个城市的4个评估点下车，总共1600名参与者。采用基于目标人群最高乘车时间的系统抽样策略，将在公交车站附近的私人空间收集下车的年轻人的数据，并记录在手持手机上。具体目标包括对“现实核查”在增加艾滋病毒检测（主要结果）、检测的理论中介、避孕套使用和禁欲方面的效果进行试点测试，并与对照相比减少对同性恋的恐惧和艾滋病毒/艾滋病的污名。还将检查治疗城市与对照城市对艾滋病毒检测率的影响。这项研究将为干预的效果提供初步证据，这种干预可以非常经济有效地传播，并通过公共汽车在另外4个城市进行大规模传播，TEZO系统无限公司，拥有Transit TV的公司，计划在这些城市进行广播。

DESCRIPTION (provided by applicant): This application proposes to evaluate an already-created serial drama intervention, "Reality Check," on public buses in Los Angeles, CA. Young African Americans are very disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs). Social factors affecting their risk include poverty, poor access to preventive medical services, and homophobia, which causes some men who have sex with men (MSM) to be secretive about these activities and to be reluctant to be tested for HIV. Unfortunately, many of those infected with HIV are unaware of their infection and may be transmitting it, especially during the highly infectious acute infection stage. On the other hand, those who test positive reduce their risk-related behavior dramatically. Thus, the CDC has recommended universal HIV testing, but especially testing among those at highest risk. Accordingly, the broad, long-term objective of this application is to increase HIV testing among young African Americans. It proposes a pilot test of the effects of an innovative, theory-based HIV risk-reduction serial drama intervention, "Reality Check," among African Americans aged 14 to 24 years who ride public buses in impoverished African American neighborhoods in Los Angeles. "Reality Check" is a structural intervention in that it will be implemented in the natural environment of bus riders. It consists of 27 3-minute episodes. Each episode will be shown for 1 week on Tuesday, Thursday, Friday and Saturday, once each hour, on all public buses in Los Angeles, which are equipped with video screens. Previously shown episodes will be available on a YouTube link from Transit TV's website. The study will use a quasi-experimental control group design with pre- and multiple post-intervention assessments. Riders of public buses in impoverished African American neighborhoods in Richmond, CA, will serve as the control. Cross-sectional anonymous bus stop surveys of African American youth aged 14-24 who ride the bus through-and reside in--designated impoverished areas of both cities at least 3 times each week will be conducted before "Reality Check" is shown in Los Angeles, immediately after it is shown, and 3 and 6 months after it is shown. The study sample will include 200 youth who exit buses in each of the 2 cities at each of the 4 assessment points, for a total of 1,600 participants. Using a systematic sampling strategy based on the target population's times of highest ridership, data will be collected in private spaces near the bus stops from youth who exit the buses and recorded on hand-held mobile phones. The Specific Aims include conducting a pilot test of the effects of "Reality Check" in increasing HIV testing (the primary outcome), theoretical mediators of testing, condom use, and abstinence, and reducing homophobia and HIV/AIDS stigma, as compared with control. Effects on HIV testing rates in treatment versus control city also will be examined. This research would provide preliminary evidence of the effects of an intervention that could be disseminated very cost-effectively, with substantial reach via public buses in 4 additional cities where TEZO Systems Unlimited, Inc., the company that owns Transit TV, plans to broadcast. PUBLIC HEALTH RELEVANCE: Young African Americans are highly disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs). This study evaluates the effectiveness of a serial drama, delivered on local buses, at changing attitudes and/or behaviors among young African Americans. This research responds to the urgent public health need for structural interventions to reduce the risk of STIs, including HIV, in young African Americans.