Community Mobilization to Improve the HIV/AIDS Continuum of Care Among Black Men

社区动员以改善黑人男性的艾滋病毒/艾滋病连续护理

• 批准号: 8604646
• 负责人: Susan M. KEGELES
• 金额: $ 60.11万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-12 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8604646
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; African American; Age; Anal Sex; Beryllium; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Collaborations; Communities; Continuity of Patient Care; Contracts; County; Cross-Sectional Studies; Data; Death Rate; Diffuse; Elements; Ethnography; Foundations; Frequencies; Funding; Goals; Grant; HIV; HIV Infections; Health; Health Services; Healthcare; Human immunodeficiency virus test; Incidence; Indium; Individual; Insurance; Intervention; Interview; Latino; Link; Logistics; Medical; Methods; Modeling; Outcome; Pharmaceutical Preparations; Primary Prevention; Public Health; Race; Randomized; Relative (related person); Research; Research Infrastructure; Resources; Risk Behaviors; Self Efficacy; Services; Social support; Testing; Texas; Time; Transportation; Unsafe Sex; Viral Load result; Work; aged; antiretroviral therapy; base; cohort; design; efficacy testing; empowered; empowerment; experience; improved; killings; literacy; men; men who have sex with men; prevent; programs; psychosocial; public health relevance; sexually active; social norm; social stigma; theories; transmission process

DESCRIPTION (provided by applicant): HIV rates are at catastrophic levels among young black men who have sex with men (YBMSM). A study in 21 US cities found that 21% of YBMSM aged 18-29 were HIV+, compared to 9% of Latino and 7% of white young MSM (YMSM), and these disparities are worsening. YBMSM are more likely to be HIV-infected, less likely to be aware of their HIV-infection, and less likely to disclose that they are HIV-infected, relative to men of other ethnic/racial groups. HIV+ YBMSM are also less likely than white MSM to be in treatment for HIV and to have undetectable viral loads (VLs). When HIV+ individuals achieve an undetectable VL, their own health improves, and they are also less infectious to others. Getting to that point, however, requires that HIV+ individuals: (1) know their HIV status; (2) link to HIV care; (3) stay in care over time; (4) begin appropriate treatment; and (5) adhere to antiretroviral therapy (ART). We refer to these steps as engagement in the HIV Care Continuum (CC). While these approaches have great potential to reduce HIV incidence, it is estimated that only 25% of HIV+ people in the US have engaged in the CC to the point of having undetectable VLs. Research suggests that HIV+ YBMSM engage in the CC far less than others. A community-level intervention (CLI) to build and mobilize communities of YBMSM to support HIV+ men to engage in the CC, decrease psychosocial barriers and increase psychosocial facilitators to engage in the CC within those communities may be an efficacious approach to prevent HIV transmission and improve health outcomes for YBMSM. This proposal will test the efficacy of such a CLI model, called United Black Element+ (UBE+). UBE+ will be an adaptation of a current CLI, called UBE. UBE has already engaged hundreds of YBMSM in Dallas TX, and it diffuses support for HIV prevention and creates positive social norms around reducing rates of unprotected sex and increasing regular HIV testing by building an empowered, mobilized YBMSM community. UBE+ will be an adaptation and extension of UBE designed to increase YBMSM's engagement in the CC. The aims of this project are: (1) To adapt and expand UBE into UBE+, a multilevel intervention that includes a new focus on increasing engagement in the CC among HIV+YBMSM, including targeting psychosocial barriers and facilitators to engaging in the CC that are experienced in this community (e.g., HIV stigma and social support); (2) To implement UBE+ in Dallas for 3 years in collaboration with a local AIDS Service Organization currently implementing UBE, the Dallas County Health Department, and the Texas Department of State Health Services' (TDSHS) HIV-STD Program; and (3) To evaluate the efficacy of UBE+ in increasing engagement in the CC in Dallas (utilizing Houston as a control community) using 2 independent methods: (a) a longitudinal cohort of HIV+ YBMSM providing data on engagement in care, and experiences of psychosocial and logistic barriers and facilitators to engagement in care; and (b) public health data that the TDSHS independently collects on HIV+ YBMSM's engagement in the CC.

描述（由申请人提供）：艾滋病毒感染率是在灾难性的水平，在年轻的黑人男子谁与男性发生性关系（YBMSM）。在美国21个城市进行的一项研究发现，18-29岁的YBMSM中有21%是艾滋病毒阳性，而拉丁裔和白色年轻男男性接触者（YMSM）中的这一比例分别为9%和7%，而且这些差距正在恶化。与其他族裔/种族群体的男性相比，YBMSM更有可能感染艾滋病毒，不太可能意识到自己感染了艾滋病毒，也不太可能透露自己感染了艾滋病毒。HIV+ YBMSM也比白色MSM更不可能接受HIV治疗和检测不到病毒载量（VL）。当HIV+个体达到无法检测到的VL时，他们自己的健康状况会改善，并且他们对他人的传染性也会降低。然而，要达到这一点，需要艾滋病毒阳性者：（1）了解自己的艾滋病毒状况;（2）与艾滋病毒护理联系起来;（3）长期接受护理;（4）开始适当的治疗;（5）坚持抗逆转录病毒治疗。 治疗（ART）。我们将这些步骤称为参与艾滋病毒护理连续体（CC）。虽然这些方法具有降低HIV发病率的巨大潜力，但据估计，在美国，只有25%的HIV+人群参与了CC，达到了无法检测到VL的程度。研究表明，艾滋病毒+ YBMSM参与CC远远低于其他人。社区一级的干预措施（CLI），建立和动员YBMSM社区，以支持艾滋病毒阳性男子参与CC，减少心理障碍，增加心理社会促进者参与CC在这些社区内可能是一个有效的方法，以防止艾滋病毒传播和改善YBMSM的健康结果。该提案将测试这种CLI模型的有效性，称为联合黑元素+（UBE+）。UBE+将是对当前CLI的改编，称为UBE。UBE已经在德克萨斯州的达拉斯与数百名YBMSM接触，它传播了对艾滋病毒预防的支持，并通过建立一个授权的、动员的YBMSM社区，围绕降低无保护性行为的比率和增加定期的艾滋病毒检测建立了积极的社会规范。UBE+将是UBE的改编和扩展，旨在增加YBMSM在CC中的参与。该项目的目标是：（1）将UBE调整和扩展为UBE+，这是一种多层次的干预措施，其中包括一个新的重点，即增加艾滋病毒阳性的YBMSM参与CC，包括针对该社区中经历过的心理社会障碍和参与CC的促进者（例如，（2）在达拉斯与目前正在实施UBE的当地艾滋病服务组织、达拉斯县卫生局和得克萨斯州卫生服务部（TDSHS）艾滋病毒-性病方案合作，实施UBE+3年;评估UBE+在提高达拉斯社区参与度方面的效果（利用休斯顿作为对照社区）使用2种独立的方法：（a）HIV+ YBMSM的纵向队列，提供有关参与护理的数据，以及参与护理的心理社会和后勤障碍和促进者的经验;以及（B）TDSHS独立收集的关于HIV+ YBMSM参与CC的公共卫生数据。