Optimizing HIV counseling testing and referral through an adaptive drug use intervention

 描述（由申请人提供）：与男性发生性关系的年轻男性（YMSM）（15-25岁）不太可能知道他们的艾滋病毒状况比老年男男性接触者。HIV阳性的YMSM也不太可能被病毒抑制。使这些年轻人面临更高风险的结构性过程 艾滋病毒感染也增加了他们使用、误用和滥用药物的脆弱性。这些相互交织的流行病造成了反馈循环，使吸毒的YMSM无法获得最佳的艾滋病毒预防和护理服务。鉴于美国对药物使用者所面临的艾滋病毒预防和护理服务差距的关注有限且不一致，符合当前RFA的目的，即寻找、检测、治疗和留住感染艾滋病毒或有感染艾滋病毒高风险的青少年和年轻人（RFA-DA-15-019），我们建议开发和评估一种创新的服务提供模式，该模式将物质使用简短干预（SUBI）在底特律大都会区为高危YMSM提供服务的三个最大的艾滋病服务组织（阿索）的艾滋病毒标准护理（SOC）服务中。干预包括两次ASO访问，此时参与者从经过培训的HIV检测顾问那里接受SOC或SUBI。在每次干预访视时，300名YMSM将接受SOC或SUBI。为了检查干预措施的顺序如何影响疗效，我们建议在基线时将600 ATOD使用的15-25岁的高危YMSM在DMA中随机分为4组析因随机对照试验（仅SOC，SOC+SUBI，SUBI+SOC，SUBI+SUBI）。我们将在15个月内跟踪YMSM，每3个月收集一次行为和生物标志物（STI，物质使用）数据。我们的分析还将评估和包括精确度水平的保真度、可接受性和满意度、成本效益和可持续性。试验结果可能提供一种新的策略，将物质使用干预纳入艾滋病毒护理标准，并优化向使用物质的YMSM提供艾滋病毒服务。

 DESCRIPTION (provided by applicant): Young men who have sex with men (YMSM) (aged 15-25) are less likely to know their HIV status than older MSM. HIV-positive YMSM are also less likely to be virally suppressed. The structural processes that place these youth at higher risk for HIV infection also increase their vulnerability for substance use, misuse, and abuse. These intertwining epidemics create feedback loops that negate the optimal delivery of HIV prevention and care services to substance-using YMSM. Given the limited and inconsistent focus placed on the HIV prevention and care service gaps faced by substance using) in the United States, Consistent with the current RFA's purpose to Seek, Test, Treat And Retain Youth And Young Adults Living With Or At High Risk For Acquiring HIV (RFA-DA-15-019), we propose to develop and evaluate an innovative service delivery model that integrates a substance use brief intervention (SUBI) within HIV standard of care (SOC) services in the three largest AIDS Service Organizations (ASO) serving high-risk YMSM in the Detroit Metro Area. The intervention comprises of two ASOs visits, at which time participants receive either SOC or SUBI from a trained HIV test counselor. At each intervention visit, 300 YMSM will receive SOC or SUBI. To examine how the sequencing of interventions impacts efficacy we proposed to randomize at baseline 600 ATOD-using high-risk YMSM aged 15-25 in the DMA into a 4-arm factorial randomized controlled trial (SOC-only, SOC+SUBI, SUBI+SOC, SUBI+SUBI). We will follow YMSM over a 15-month period, collecting both behavioral and biomarker (STIs, Substance Use) data every 3 months. Agency-level fidelity, acceptability and satisfaction, cost-effectiveness, and sustainability will also be evaluated and included in our analyses. Trial findings may offer a novel strategy to integrate substance use interventions into HIV standard of care and optimize the delivery of HIV services to substance- using YMSM.