Network Supported Engagement in HIV Care for Younger Black Men

描述(由申请人提供)：这个项目的目标是完善和试点测试一种灵活的网络支持的护理参与(NSEC)干预措施，该干预措施招募并激励最近确诊为艾滋病毒的年轻黑人男男性行为者(YBMSM)的一个或多个有机社会支持网络成员，以提高对艾滋病毒初级保健的参与度。虽然年轻的黑人男性有关于艾滋病毒感染和抗逆转录病毒依从性相关因素的数据，但缺乏对关键中间体的经验性干预。 治疗级联中的一步：保留在护理中。几个现有的战略寻求解决在护理中保留的挑战，包括同伴支持小组、病例管理计划、多模式同伴外联和同伴健康导航。所有这些努力都有一个共同的组成部分--新创建的网络成员--一种传统的公共卫生干预方法。这些战略往往缺少协调一致的努力，以利用自然存在的有机社会支持网络。我们使用的“有机”指的是一个内生的现有网络；可以与新产生的支持人员形成对比，例如指定的同行导航员或非专业卫生工作者。有机社会支持是促进艾滋病毒感染者健康的一股强大力量，这一概念得到了很好的证明；但在将新诊断为艾滋病毒感染者的YBMSM保留在护理中方面，这一概念没有得到充分利用。艾滋病毒携带者需要持久、深入和持续的社会支持；支持往往只来自现有的知己--朋友、伴侣、亲戚和其他个人--人们可能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)的因素来选择支持密友(SC)。这类干细胞可能不仅对保持护理很重要，而且对持续的健康维持、降低风险的行为维持和长期坚持抗逆转录病毒药物(ARV)也很重要。我们开发了一种基于理论和概念的NSEC简短干预，1)利用社会支持网络可视化和网络理论来帮助 YBMSM安全地确定一名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)模型来激活和维持二人组内特定于艾滋病毒的社会支持；以及3)使用相关联的特定于HIV的社会支持概念模型来推动YBMSM指数之间的预约遵守。我们的主要目标是：1)完善干预方案、材料和评估，1)协调通过个人和二元会话激活SC的干预组成部分；2)通过针对双方成员的互动迷你助推器手机/短信会话，系统化对指数的社会支持；以及2)初步测试可行性和初步效果(较低 在随机抽样后3个月和12个月，94名16-29岁的YBMSM样本中，NSEC干预与标准联系护理的错过就诊比例(MVP)。要评估的次要结果包括二元亲密度、自我效能和社会支持、抗逆转录病毒依从性和艾滋病毒载量。

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.