STAR-Seek, Test and Retain. Linkages for Black HIV+, Substance Using MSM

STAR-寻找、测试和保留。

• 批准号: 8452168
• 负责人: WAFAA M. EL-SADR
• 金额: $ 52.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-15 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8452168
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Affect; African American; Age; Alcohol consumption; Alcohol or Other Drugs use; Behavior; CD4 Lymphocyte Count; Caring; Characteristics; Cities; Counseling; Diagnosis; Early Diagnosis; Education; Effectiveness; Epidemic; Ethnic group; Gays; General Population; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Human immunodeficiency virus test; Income; Individual; Infection; Intervention; Knowledge; Link; Mental disorders; Methods; New York City; Outcome; Participant; Patients; Population; Population Heterogeneity; Prevalence; Prevention; Primary Health Care; Public Health; Race; Randomized; Recruitment Activity; Respondent; Risk; Risk Behaviors; Sampling; Services; Social Characteristics; Target Populations; Test Result; Testing; Therapeutic; United States; Ursidae Family; Use Effectiveness; Visit; antiretroviral therapy; arm; cost; cost effectiveness; experience; financial incentive; high risk; innovation; men who have sex with men; novel; peer; prevent; prevention service; racial and ethnic; response; social stigma; success; transmission process

DESCRIPTION (provided by applicant): The HIV epidemic in the United States most severely affects men who have sex with men (MSM): 57% of all new infections occur in this population. Black MSM bear a disproportionate burden, with prevalence of 28%, in contrast to 19% in MSM overall. Black MSM undergo HIV testing less frequently than other MSM; are less likely to be aware that they are HIV infected; are more likely to experience delays in entry into HIV care; and are less likely to be prescribed ART when eligible. These disparities are pronounced in substance using MSM, as substance users are at elevated risk of late diagnosis and delayed engagement in HIV care. The combination of pervasive stigma associated with MSM behavior and high rates of substance use hinders effective prevention efforts in this population, even as the prevalence of infection in Black MSM in some US cities approaches 50%. Reducing HIV-related disparities in MSM and among Black Americans are National HIV/AIDS Strategy priorities and are essential to the effort to control and prevent HIV/AIDS in the US. Setting: The study will seek and recruit substance-using Black MSM in New York City for HIV testing and will link and retain those who are HIV-infected in HIV primary care. Study Aims: In response to the urgent public health need to seek substance-using Black MSM, identify those with HIV infection, and link the latter to HIV services, the study aims are as follows: Seek and Test: Respondent driven sampling (RDS) will be used to recruit substance-using Black MSM for HIV testing. RDS has been used in HIV surveillance among hard-to-reach populations and, to a limited extent, as a strategy for engaging hard-to-reach populations in services. We will assess the feasibility and effectiveness of using RDS to seek, recruit, and offer HIV testing to this high-risk population. Link and Retain: Participants with reactive rapid HIV test results and who are not currently in care will be randomized to two linkage and retention strategies: patient navigation (PN) and financial incentives (FI). One hundred participants will be randomized into each arm of the study. The primary objectives are: 1) to assess the feasibility and effectiveness of using RDS for seeking and recruiting substance-using Black MSM at high risk for HIV acquisition for rapid HIV counseling and testing; 2) to assess the feasibility and effectiveness of using two interventions, PN and FI, for linkage and retention in HIV care; and 3) to assess the cost-effectiveness of PN and FI for linkage and retention in HIV care. This study has the potential to identify effective methods to seek and test substance-using Black MSM, to link the HIV infected to services, and to retain them in care and treatment. The success of such an effort responds to priorities with the national HIV strategy. Results will inform innovative approaches to engaging highest-risk, difficult-to-reach individuals in HIV counseling and testing and retaining them in care and treatment.

描述（由申请人提供）：美国的艾滋病毒流行病对男男性行为者（MSM）的影响最严重：57%的新感染发生在这一人群中。黑人男男性行为者承担着不成比例的负担，患病率为28%，而男男性行为者总体患病率为19%。黑人男男性行为者接受艾滋病毒检测的频率低于其他男男性行为者;他们不太可能意识到自己感染了艾滋病毒;更有可能延迟进入艾滋病毒护理;并且在符合条件时不太可能接受抗逆转录病毒治疗。这些差异在使用物质的男男性行为者中很明显，因为物质使用者延迟诊断和延迟参与艾滋病毒护理的风险很高。与MSM行为相关的普遍耻辱感和高物质使用率的结合阻碍了这一人群的有效预防工作，即使在美国一些城市黑人MSM的感染率接近50%。减少男男性行为者和美国黑人之间与艾滋病毒相关的差异是国家艾滋病毒/艾滋病战略的优先事项，对美国控制和预防艾滋病毒/艾滋病的努力至关重要。设定：这项研究将在纽约市寻找和招募使用物质的黑人男男性行为者进行艾滋病毒检测，并将那些艾滋病毒感染者联系起来，保留在艾滋病毒初级保健中。研究目的：为了响应公共卫生的迫切需要，寻求物质使用的黑人男男性接触者，确定那些与艾滋病毒感染，并将后者与艾滋病毒服务，研究的目的如下：寻求和测试：受访者驱动的抽样（RDS）将被用来招募物质使用的黑人男男性接触者进行艾滋病毒检测。RDS已被用于难以接触到的人群中的艾滋病毒监测，并在有限程度上作为一种战略，使难以接触到的人群参与服务。我们将评估使用RDS寻求，招募和提供艾滋病毒检测到这一高风险人群的可行性和有效性。链接和保留：具有反应性快速HIV检测结果且目前未接受护理的参与者将被随机分配到两种联系和保留策略：患者导航（PN）和经济激励（FI）。100名受试者将随机分配至研究的每个组。主要目标是：1）评估使用RDS寻求和招募HIV感染高风险的使用物质的黑人MSM进行快速HIV咨询和检测的可行性和有效性; 2）评估使用两种干预措施PN和FI进行HIV护理中的联系和保留的可行性和有效性; 3）评估PN和FI进行HIV护理中的联系和保留的成本效益。这项研究有可能确定有效的方法来寻求和测试使用物质的黑人男男性行为者，将艾滋病毒感染者与服务联系起来，并将他们留在护理和治疗中。这种努力的成功符合国家艾滋病毒战略的优先事项。研究结果将为创新方法提供信息，使高风险、难以接触的个人参与艾滋病毒咨询和检测，并使他们继续接受护理和治疗。