Social Media Based Peer Led Intervention to Facilitate PrEP in YMSM of Color

描述(由申请人提供)：与男性发生性关系的有色人种青年男性(13-29岁)在美国经历了最高的艾滋病毒新感染率，现有的预防干预措施未能覆盖到大多数难以接触到的人群。然而，艾滋病毒预防方面的最新发展有望帮助扭转基督教青年会艾滋病毒感染率上升的趋势，以及艾滋病毒的总体负担。暴露前预防(PrEP)是一种由未感染艾滋病毒的人每天服用的口服抗逆转录病毒方案，以防止艾滋病毒感染，已证明在多种高危人群中降低艾滋病毒感染风险的有效性。与此同时，年轻人，包括低收入的基督教青年会，越来越普遍地使用社交媒体(如Facebook、Twitter、在线约会网站)，这提供了一种有效的途径来识别和接触到许多原本很难接触到的基督教青年会。这项有指导的职业发展奖提案的总体目标是开发和试行一种基于社交媒体的同行主导的干预措施，以促进基督教青年会采用PrEP。我们将使用混合方法和“创新扩散”框架来：(1)确定与YMCSM对PrEP感兴趣和采用PrEP的相关因素；(2)利用PrEP(E-PrEP)发展赋权，这是一种以社交媒体为基础的同行主导的干预措施，以增加YMCSM对PrEP的接受；以及(3)初步测试E-PrEP提高YMCSM使用和采用PrEP的意向的可行性和初步效果。在多学科专家导师团队的指导下，我将对PrEP的用户和非采用者进行面对面的定性访谈，以确定当前的推动者和采用它的障碍。使用“创新扩散”理论框架来解释我们的发现，然后我将与基督教青年会的同行领导人合作，开发基于社交媒体的干预措施，以促进PrEP的普及。由此产生的E-PrEP干预将利用同行领导人指导的在线信息和讨论来提供关于PrEP的教育，增加对PrEP使用的兴趣，并促进PrEP的获取。然后，我们将在18-29岁的青年会中进行E-PrEP的试点随机试验(与在线信息和促进一般健康和营养的讨论的暴露)，以评估E-PrEP在增加青年会自我报告意向和接受PrEP方面的可行性和初步有效性。我们假设，与对照组相比，与暴露于专注于一般健康主题的非重叠在线内容的对照组相比，随机接受E-PrEP的参与者更有可能表达使用和使用PrEP的意图。一旦我们初步确定了E-PrEP疗效的效应大小，我们将提交一份R01申请，在多中心随机试验中在YMCSM中测试E-PrEP。在获奖期间，我将发展基于社交媒体和技术的健康干预方面的专业知识，包括相关的伦理挑战，我还将继续进行纵向和定性数据分析方面的高级培训。我计划的研究和职业发展活动的完成将使我能够成为一名独立的调查者，研究新的生物行为干预措施，以改善难以接触到的人群的健康。

DESCRIPTION (provided by applicant): Young men of color who have sex with men (YMCSM, ages 13-29) experience the highest rates of new HIV infections in the U.S., with existing prevention interventions failing to reach most of this hard to reach population. Recent developments in HIV prevention, however, hold promise to help reverse the trend of rising HIV rates in YMCSM, as well as the overall burden of HIV. Pre-exposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, has demonstrated efficacy for reducing HIV acquisition risk in multiple high-risk populations. At the same time, increasingly ubiquitous use of social media (e.g. Facebook, Twitter, online dating sites) by young people, including low- income YMCSM, provides an efficient avenue to identify and reach many otherwise hard to reach YMCSM. The overall goal of this mentored career development award proposal is to develop and pilot-test a social media-based peer-led intervention to promote PrEP uptake in YMCSM. We will use mixed methods and a 'diffusion of innovation' framework to: (1) determine factors associated with interest in and adoption of PrEP among YMCSM; (2) develop Empowering with PrEP (E-PrEP), a social media-based peer-led intervention to increase PrEP uptake in YMCSM; and (3) pilot-test the feasibility and preliminary efficacy of E-PrEP for increasing intention to use and adoption of PrEP by YMCSM. With guidance from a multi-disciplinary team of expert mentors, I will conduct in-person qualitative interviews with users and non-adopters of PrEP to identify current facilitators of and barriers to its uptake. Using the 'diffusion of innovation' theoretical framework to interpret our findings, I ill then partner with YMCSM peer leaders to develop a social media-based intervention to facilitate PrEP uptake. The resulting E-PrEP intervention will use online messaging and discussions directed by peer leaders to provide education on PrEP, increase interest in PrEP use, and facilitate access to PrEP. We will then conduct a pilot randomized trial of E-PrEP (versus exposure to online messaging and discussions promoting general health and nutrition) in YMCSM ages 18-29 to assess E-PrEP's feasibility and preliminary efficacy for increasing self-reported intention in and uptake of PrEP among YMCSM. We hypothesize that, compared to a control group exposed to non-overlapping online contents focused on general health topics, participants randomized to E-PrEP will be more likely to express intention to use and to use PrEP. Once we have preliminarily determined an effect size for E-PrEP's efficacy, we will submit an R01 application to test E-PrEP among YMCSM in a multi-center randomized trial. During the award period, I will develop expertise in social media- and technology-based health interventions, including associated ethical challenges, and I will also pursue advanced training in longitudinal and qualitative data analysis. Completion of my planned research and career development activities will allow me to become an independent investigator of novel bio-behavioral interventions for improving the health of hard to reach populations.