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

STAR-寻找、测试和保留。

• 批准号: 9086904
• 负责人: WAFAA M. EL-SADR
• 金额: $ 12.81万
• 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 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9086904
• 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对男男性行为者 (MSM) 的影响最为严重：所有新感染病例中 57% 发生在这一人群中。黑人 MSM 承受着不成比例的负担，患病率为 28%，而 MSM 总体患病率为 19%。黑人 MSM 接受 HIV 检测的频率低于其他 MSM；不太可能意识到自己感染了艾滋病毒；更有可能延迟接受艾滋病毒护理；并且在符合条件时不太可能接受 ART。这些差异在使用 MSM 的物质中尤为明显，因为物质使用者的晚期诊断和延迟参与艾滋病毒护理的风险较高。尽管美国一些城市黑人 MSM 的感染率接近 50%，但与 MSM 行为相关的普遍耻辱和高物质使用率相结合阻碍了该人群的有效预防工作。减少男男性行为者和美国黑人中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，对于美国控制和预防艾滋病毒/艾滋病的努力至关重要。背景：该研究将在纽约市寻找和招募使用药物的黑人男男性接触者进行艾滋病毒检测，并将在艾滋病毒初级保健中联系和留住艾滋病毒感染者。研究目的：为了满足公共卫生的迫切需求，寻找使用药物的黑人男男性接触者，识别艾滋病毒感染者，并将后者与艾滋病毒服务联系起来，该研究的目标如下： 寻求和测试：受访者驱动抽样（RDS）将用于招募使用药物的黑人男男性接触者进行艾滋病毒检测。 RDS 已用于难以接触人群的艾滋病毒监测，并在一定程度上作为让难以接触人群参与服务的策略。我们将评估使用 RDS 为这一高危人群寻找、招募和提供 HIV 检测的可行性和有效性。链接和保留：具有反应性快速 HIV 检测结果且当前未接受护理的参与者将被随机分配到两种链接和保留策略：患者导航 (PN) 和经济激励 (FI)。一百名参与者将被随机分配到研究的每个组中。主要目标是： 1) 评估使用 RDS 寻找和招募 HIV 感染高风险的吸毒黑人 MSM 进行快速 HIV 咨询和检测的可行性和有效性； 2) 评估使用 PN 和 FI 这两种干预措施来连接和保留艾滋病毒护理的可行性和有效性； 3) 评估 PN 和 FI 在艾滋病毒护理中的联系和保留的成本效益。这项研究有可能找到有效的方法来寻找和测试使用药物的黑人男男性接触者，将艾滋病毒感染者与服务联系起来，并让他们接受护理和治疗。这一努力的成功响应了国家艾滋病毒战略的优先事项。结果将为创新方法提供信息，让风险最高、难以接触的个人参与艾滋病毒咨询和检测，并让他们继续接受护理和治疗。