Network Supported Engagement in HIV Care for Younger Black Men

描述（由申请人提供）：本项目的目标是完善和试点测试一个灵活的网络支持的参与护理（NSEC）干预，招募和激励一个或多个有机的社会支持网络成员最近被诊断为艾滋病毒的年轻黑人男子谁与男性发生性关系（YBMSM），以改善参与艾滋病毒初级保健。虽然有关于黑人青年感染艾滋病毒和坚持抗逆转录病毒治疗的相关因素的数据，但缺乏对一个关键中间环节的经经验检验的干预措施。 治疗级联中的一步：继续护理。一些现有的战略寻求解决的挑战，以保持在照顾，包括同行支持小组，个案管理计划，多模式的同行外展，同行健康导航。这些努力都有一个共同的组成部分-新成立的网络成员-传统的公共卫生干预方法。这些战略往往缺乏的是协调努力，利用自然存在的有机社会支持网络。我们使用的“有机”是指一个内源性的现有网络，并可以与新产生的支持人员，如指定的同行导航员或外行卫生工作者。有机的社会支持的概念，作为一个强大的力量，在健康的艾滋病毒感染者是有据可查的，但一直没有得到充分利用，以保持新诊断为艾滋病毒的YBMSM在照顾。艾滋病毒感染者需要持久、深入和持续的社会支持;这种支持往往只能从现有的知己-朋友、伙伴、亲属和其他个人-那里获得，因为一个人可能会与他们分享个人信息并受到他们的影响。NSEC的灵活性确保了基于诸如提供支持功能（例如，情感支持）而不是他们的状态（例如，母亲）。这种SC可能不仅对保持护理很重要，而且对持续的健康维护、风险降低行为维持和长期坚持抗逆转录病毒药物（ARV）也很重要。我们已经开发了一个理论和概念接地NSEC简短的干预，1）利用社会支持网络可视化和网络理论，以帮助 YBMSM安全地确定一个SC从事护理活动中的保留; 2）使用针对SC的信息动机行为技能（IMB）模型，以激活和维持二分体内的艾滋病毒特异性社会支持;和3）使用一个链接的艾滋病毒特异性社会支持概念模型，然后驱动指数YBMSM之间的预约遵守。我们的主要目标是：1）通过以下方式完善干预方案、材料和评估：1）通过个人和二元会话协调激活SC的干预组件; 2）通过针对二元成员的交互式微型助推器手机/文本会话系统化指数的社会支持;以及2）试点测试可行性和初始功效（较低 在随机化后3个月和12个月，在94名年龄16-29岁的YBMSM样本中，NSEC干预与标准护理联系的错过访视比例（MVP）。待评估的次要结局包括二元亲密度、自我效能和社会支持、抗逆转录病毒治疗依从性和HIV病毒载量。

DESCRIPTION (provided by applicant): This goal of this project is to refine and pilot test a flexible Network Supported Engagement in Care (NSEC) intervention that recruits and motivates one or more organic social support network members of recently HIV diagnosed young black men who have sex with men (YBMSM) to improve engagement in HIV primary care. While data exist for young black men on factors related to HIV acquisition and antiretroviral adherence, there is a lack of empirically tested interventions on a key intermediate step in the treatment cascade: retention in care. Several existing strategies seek to address challenges to retention in care, including peer support groups, case management programs, multi-modal peer outreach, and peer health navigation. These efforts all share a common ingredient - newly created network members - a traditional public health intervention approach. What is often missing in these strategies is a coordinated attempt to harness organic social support networks that naturally exist. Our use of "organic" refers to an endogenous existing network; and can be contrasted to newly generated support persons such as assigned peer navigators or lay health workers. The concept of organic social support as a powerful force in the health of HIV infected persons is well documented; but has been underutilized to retain YBMSM newly diagnosed with HIV in care. Living with HIV requires persistent, deep and ongoing social support; support often only available from existing confidants - friends, partners, kin and other individuals - with whom one might share personal information with and be influenced by. Flexibility of NSEC ensures that a support confidant (SC) is selected based upon factors such as providing a supportive function (e.g., emotional support) as opposed to their status (e.g., mother). Such SCs are likely important not only to retention in care, but also to sustained health maintenance, risk reduction behavior maintenance and long-term adherence to antiretrovirals (ARVs). We have developed a theoretically and conceptually grounded NSEC brief intervention that 1) utilizes social support network visualization and network theory to help YBMSM safely identify a SC to engage in retention in care activities; 2) uses an Information-Motivation-Behavioral Skills (IMB) Model targeted at the SC to activate and maintain HIV-specific social support within the dyad; and 3) uses a linked HIV-specific social support conceptual model to then drive appointment adherence among the index YBMSM. Our primary aims are to: 1) Refine intervention protocol, materials and assessments by 1) coordinating intervention components that activate the SC through individual and dyadic sessions; and 2) systemizing social support of the index via interactive mini-booster cell-phone/text sessions directed at both members of the dyad; and 2) Pilot test the feasibility and initial efficacy (lower missed visit proportion (MVP) of the NSEC intervention versus standard linkage to care at 3- and 12- months post randomization among a sample of 94 YBMSM, ages 16-29. Secondary outcomes to be assessed include dyadic closeness, self- efficacy and social support, antiretroviral adherence and HIV viral load.