Exploring Strategies to Promote Frequent Testing among MSM

探索促进MSM频繁检测的策略

• 批准号: 8658563
• 负责人: Theodorus G.M. Sandfort
• 金额: $ 23.77万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-23 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8658563
• 关键词: AIDS diagnosis; AIDS prevention; Acquired Immunodeficiency Syndrome; Acute; Address; Advisory Committees; Affect; Age; Anti-Retroviral Agents; Behavioral; Centers for Disease Control and Prevention (U.S.); Clinical; Collaborations; Communities; Community Healthcare; Cost-Benefit Analysis; Development; Diagnosis; Early Diagnosis; Early identification; Effectiveness; Financial compensation; Frequencies; Goals; HIV; HIV Infections; HIV diagnosis; Health; Healthcare; Healthcare Systems; High Prevalence; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Interview; Knowledge; Lead; Mental Health; Minority; New York; New York City; Newly Diagnosed; Outcome Study; Persons; Policies; Population; Prevalence; Prevention approach; Prevention strategy; Qualitative Research; Recommendation; Research; Research Project Grants; Risk; Risk Behaviors; Risk-Taking; Sampling; Security; Sex Behavior; Subgroup; Test Result; Testing; Time; Unsafe Sex; Viral; Viral Load result; Woman; aged; antiretroviral therapy; base; disorder prevention; effective intervention; high risk; informant; men; men who have sex with men; multi-component intervention; prevent; public health relevance; safer sex; screening; sex; sexual risk taking; sexually active; tool; transmission process

DESCRIPTION (provided by applicant): As a crucial component of the "HIV Treatment as Prevention" approach, HIV testing has become a major tool in reducing HIV transmission. Persons who become aware of their HIV infection tend to reduce their sexual risk practices. Early identification facilitates more timely viral suppression, minimizing onward HIV transmission, including during the acute period when viral load tends to be high. While recent policies promote the routine offer of testing, additional strategies are needed to promote frequent testing for high-prevalence, high-incidence populations such as men who have sex with men (MSM). MSM are the largest risk group in the US and the only group in which new infections are increasing. MSM test more often than men who have sex with women. But relatively few MSM test as often as recommended by CDC - two to four times per year. More widespread frequent testing among MSM has ten potential to reduce the transmission of HIV in this population. While a small group of sexually active MSM have never tested for HIV, others test infrequently or delay testing until becoming symptomatic with AIDS. At the same time, a subgroup of MSM who test frequently have high levels of sexual risk; while unprotected sex can motivate HIV testing, testing confers a false sense of security and may lead to greater risk-taking. Research has identified individual and structural determinants for HIV testing in general; frequent HIV testing is, however, likely to respond to a different set of determinants. It is also ot known to what extent frequent testing is feasible and for which groups of sexually-active MSM. The few evaluated interventions that promote HIV testing in MSM have not addressed HIV testing that is frequent. In order to develop strategies that can promote frequent testing while reinforcing safer sex practices and avoiding risk compensation, an in-depth understanding is needed of the current HIV testing practices of MSM, how testing relates to sexual risk-taking, and the factors that promote or impede frequent HIV testing. In order to accomplish our goals, we propose a two-year developmental research project in which we will (1) conduct in-depth interviews with a purposive sample of 72 MSM in NYC, 18 to 39 years old, from diverse sociocultural backgrounds and with a range of HIV testing frequencies, and with 10 key informants; (2) use findings to identify potentially effective strategies to promote frequent testig for sexually- active MSM who never test, test infrequently, or test regularly but at less than optimal frequency, that simultaneously prevent frequent testing from becoming an alternative to safer sex practices; and (3) establish an NYC MSM HIV Testing Task Force of diverse stakeholders to assist in implementing the research, analyzing findings, and identifying prevention strategies. This project is a collaboration between the NYC Department of Health and Mental Hygiene and the HIV Center for Clinical and Behavioral Studies. Based on the study outcomes, we plan to develop, implement and evaluate a multi-component intervention to promote frequent HIV testing among diverse MSM in NYC.

描述(申请人提供)：作为“艾滋病毒治疗即预防”方法的重要组成部分，艾滋病毒检测已成为减少艾滋病毒传播的主要工具。意识到自己感染艾滋病毒的人往往会减少他们的性行为风险。及早识别有助于更及时地抑制病毒，最大限度地减少艾滋病毒的进一步传播，包括在病毒载量往往较高的急性期。虽然最近的政策促进了常规检测的提供，但需要更多的战略来促进对高流行率、高发病率人群，如男男性行为者(MSM)的频繁检测。男男性接触者是美国最大的风险群体，也是新感染人数增加的唯一群体。男男性接触者比与女性发生性关系的男性更频繁地进行MSM检测。但相对较少的男男性接触者检测频率与疾控中心建议的一样--每年两到四次。在男男性接触者中进行更广泛的频繁检测有十个潜力可以减少艾滋病毒在这一人群中的传播。虽然一小撮性行为活跃的男男性接触者从未检测过艾滋病毒，但其他人检测不频繁或推迟检测，直到出现艾滋病症状。与此同时，经常检测的一群男男性接触者有很高的性风险；虽然无保护措施的性行为会激发艾滋病毒检测，但检测会带来虚假的安全感，并可能导致更大的风险承担。研究已经确定了艾滋病毒检测的个人和结构性决定因素；然而，频繁的艾滋病毒检测可能会对一组不同的决定因素做出反应。也不知道频繁检测在多大程度上是可行的，以及对哪些性行为活跃的MSM群体来说是可行的。在男男性接触者中促进艾滋病毒检测的为数不多的评价干预措施没有解决频繁的艾滋病毒检测问题。为了制定能够促进频繁检测的战略，同时加强安全的性行为做法和避免风险补偿，需要深入了解当前男男性行为者的艾滋病毒检测做法、检测与性风险承担的关系，以及促进或阻碍频繁的艾滋病毒检测的因素。为了实现我们的目标，我们提出了一个为期两年的发展研究项目，在这个项目中，我们将(1)对纽约市72名MSM进行深入访谈，这些样本来自不同的社会文化背景和一系列艾滋病毒检测频率，并与10名关键线人进行有目的的访谈；(2)利用研究结果确定潜在的有效策略，促进性行为活跃的MSM进行频繁测试，这些MSM从不测试、不频繁测试或定期测试但频率低于最佳频率，同时防止频繁测试成为更安全的性行为实践的替代；以及(3)建立一个由不同利益相关者组成的纽约市男男性接触者艾滋病毒检测工作组，以协助实施研究、分析结果和确定预防策略。该项目是纽约市卫生和精神卫生部门与艾滋病毒临床和行为研究中心之间的合作项目。根据研究结果，我们计划开发、实施和评估一项多成分干预措施，以促进纽约市不同男男性接触者之间频繁的艾滋病毒检测。