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

 描述(由申请人提供)：与年龄较大的男男性接触者(15-25岁)相比，与男男性接触者(15-25岁)发生性行为的年轻男性不太可能知道自己的艾滋病毒状况。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 艾滋病毒感染还增加了他们使用、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，否定了向使用物质的YMSM提供艾滋病毒预防和护理服务的最佳方式。鉴于美国对艾滋病毒预防和护理服务的关注有限且不一致，为了与当前RFA寻找、检测、治疗和留住感染艾滋病毒或感染艾滋病毒高危人群的青年和青年成年人(RFA-DA-15-019)保持一致，我们建议开发和评估一种创新的服务提供模式，将物质使用短暂干预(SUBI)整合到底特律大都会地区服务于高危YMSM的三个最大艾滋病服务组织(ASO)的艾滋病毒护理标准(SOC)服务中。干预包括两次ASOS探视，届时参与者将从训练有素的艾滋病毒检测顾问那里获得SOC或SUI。在每一次干预访问中，300名基督教青年会将接受SOC或SUI。为了检验干预措施的顺序如何影响疗效，我们建议在基线600ATOD-在DMA中使用15-25岁的高危YMSM随机进入一项四组因素随机对照试验(仅SOC，SOC subi，subi SOC，subi subi)。我们将对YMSM进行为期15个月的跟踪调查，每3个月收集一次行为和生物标记物(性传播感染，物质使用)数据。还将评估机构一级的忠诚度、可接受性和满意度、成本效益和可持续性，并将其纳入我们的分析。试验结果可能提供一种新的战略，将药物使用干预措施纳入艾滋病毒护理标准，并优化向使用药物的青年男同性恋者提供艾滋病毒服务。

 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.