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

STAR-寻找、测试和保留。

• 批准号: 8653954
• 负责人: WAFAA M. EL-SADR
• 金额: $ 50.65万
• 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/8653954
• 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(申请人提供)：艾滋病毒在美国的流行对男男性行为者(MSM)影响最严重：57%的新感染病例发生在这一人群中。黑人男男性接触者承担了不成比例的负担，患病率为28%，相比之下，整个男男性接触者的患病率为19%。黑人男男性接触者接受艾滋病毒检测的频率低于其他男男性接触者；他们不太可能意识到自己感染了艾滋病毒；更有可能在进入艾滋病毒护理时遇到延误；当符合条件时，不太可能接受处方治疗。使用男男性接触者，这些差异在实质上是明显的，因为吸毒者延迟诊断和延迟参与艾滋病毒护理的风险增加。与MSM行为相关的普遍污名和高药物使用率共同阻碍了这一人群的有效预防工作，即使美国一些城市黑人MSM的感染率接近50%。减少男男性接触者和美国黑人中与艾滋病毒有关的差距是国家艾滋病毒/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。背景：这项研究将在纽约市寻找和招募使用物质的黑人男男性接触者进行艾滋病毒检测，并将那些感染艾滋病毒的人联系起来并保留在艾滋病毒初级保健中。研究目的：针对公共卫生迫切需要寻找吸食物质的黑人男男性接触者，识别HIV感染者，并将后者与艾滋病毒服务联系起来，研究目的如下：寻找和测试：将采用响应者驱动抽样(RDS)来招募吸食物质的黑色MSM进行HIV检测。RDS已被用于对难以接触到的人群进行艾滋病毒监测，并在有限程度上被用作让难以接触到的人群参与服务的一种战略。我们将评估使用RDS为这一高危人群寻找、招募和提供艾滋病毒检测的可行性和有效性。链接和保留：艾滋病毒快速检测结果呈阳性且目前不在护理中的参与者将被随机分为两种链接和保留策略：患者导航(PN)和财务激励(FI)。100名参与者将被随机分到研究的每一组。主要目标是：1)评估使用RDS寻找和招募药物的可行性和有效性；2)评估使用PN和FI两种干预措施在艾滋病毒护理中联动和保留的可行性和有效性；以及3)评估PN和FI在艾滋病毒护理中联动和保留的成本效益。这项研究有可能确定寻找和测试物质的有效方法-使用黑色MSM，将感染艾滋病毒的人与服务联系起来，并将他们保留在护理和治疗中。这一努力的成功符合国家艾滋病毒战略的优先事项。结果将提供创新的方法，使最高风险、难以接触到的个人参与艾滋病毒咨询和检测，并将他们留在护理和治疗中。