Combination HIV Prevention, Linking Prevention and Care, for Hispanic Men

针对西班牙裔男性的艾滋病毒综合预防，将预防与护理联系起来

• 批准号: 9228394
• 负责人: Carlos F. Caceres
• 金额: $ 55.7万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-17 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9228394
• 关键词: AIDS prevention; Address; Affect; Americas; Anus; Area; Caring; Chlamydia; Collaborations; Communication; Communities; Community Health; Community Health Systems; Community Healthcare; Continuity of Patient Care; Counseling; Data; Diagnosis; Diffuse; Disclosure; Discrimination; Disease; Drops; Early Diagnosis; Elements; Epidemic; Face; Frequencies; Gays; Geographic Locations; Gonorrhea; Government; HIV; HIV Infections; HIV diagnosis; Health; Health Services; Health care facility; Health system; Healthcare; Healthcare Systems; Hispanics; Homophobia; Hospitals; Human Rights; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Latin America; Learning; Lesbian Gay Bisexual Transgender; Link; Longitudinal cohort; Methods; Modeling; Patients; Peru; Peruvian; Population; Prevention; Prevention program; Provider; Public Health; Recruitment Activity; Rest; Risk; Risk Reduction; Self Management; Sexual Transmission; Sexually Transmitted Diseases; Site; Social Change; Social support; Stress; Syndrome; Testing; Unsafe Sex; Viral; base; care seeking; condoms; efficacy testing; empowered; empowerment; health care service; health data; innovation; literacy; men; men who have sex with men; prevention service; public health relevance; scale up; sex risk; skills; social; social engagement; social exclusion; social norm; social stigma; synergism; theories; transgender; transgender women; transphobia; willingness

 DESCRIPTION (provided by applicant): Despite the existence of a government-led HIV prevention program focused on men who have sex with men and transgender women (MSM/TW) for nearly two decades in Peru, HIV incidence among them remains high at 5%, and most (70-75%) HIV+ MSM/TW are unaware of their HIV status. This is similar to the rest of Latin America, where sexual transmission among MSM/TW drives the HIV epidemic. HIV prevention efforts for MSM/TW in Peru are ineffective, in part, because this population remains exposed to high levels of societal discrimination, homophobia and transphobia, because of social norms favoring silence about HIV and sexual risk, and because of lack of cultural competent health services. Moreover, HIV+ MSM/TW face substantial HIV stigma, which affects disclosure of HIV status, willingness to obtain HIV testing and care, and social support. A multilevel intervention approach is needed that addresses factors at the individual, social/community, and health system levels, to facilitate earlier detection of HIV infection; linking, retaining, and re-engagin HIV+ people in care and treatment to achieve viral suppression; sexual risk reduction among both HIV- and HIV+ people; and community mobilization around these issues to provide support for and change social norms and engagement in HIV prevention and treatment. A multilevel approach stressing prevention-care links in the Continuum of Prevention and Care (CPC), is likely to reduce barriers to HIV prevention and care through integrated activities involving both community and health facilities, while creating synergy across the intervention elements. We have developed and piloted Proyecto Orgullo (PO), a multilevel, theory-based intervention that diffuses support for and creates positive social norms around HIV prevention by building a mobilized, empowered MSM/TW community to reduce unsafe sex and promote biannual HIV testing. PO has shown to be acceptable, feasible and potentially effective. In collaboration with the Peruvian Ministry of Health (MoH) and local healthcare facilities, we now propose to develop, implement and test the efficacy of PO+, an extension of PO that will facilitate full engagement in the CPC, and strengthen the linkage between the community and the health system. If shown effective, PO+ can be scaled up throughout Peru with the support of the MoH, and used as a model elsewhere in the Americas, including the US. The project aims are: (1) to create Proyecto Orgullo+ (PO+), a comprehensive, integrated, multilevel intervention that will focus on the CPC; (2) to implement PO+ for 3 years in Lima South, in collaboration with the Peruvian MoH, hospitals that provide HIV care, and HIV testing sites; (3) to evaluate the efficacy of PO+ in affecting the CPC by using: (a) data on the CPC, including sexual risk behavior, HIV testing frequency; incidence of anal Chlamydia and gonorrhea, and engagement in care among HIV+ people, collected through longitudinal cohorts of MSM/TW in Lima South and Lima East (the control area), recruited independently of the intervention, oversampling HIV+ MSM/TW; and (b) CD4 and VL data for HIV patients, collected and provided by the MoH.

 描述（由申请人提供）：尽管秘鲁近二十年来一直存在政府主导的针对男男性行为者和跨性别女性 (MSM/TW) 的艾滋病毒预防计划，但他们中的艾滋病毒感染率仍然高达 5%，而且大多数 (70-75%) HIV+ MSM/TW 不知道自己的艾滋病毒状况。这与拉丁美洲其他地区类似，MSM/TW 之间的性传播推动了艾滋病毒的流行。秘鲁针对 MSM/TW 的艾滋病毒预防工作无效，部分原因是该人群仍然面临高度社会歧视、恐同和跨性别者恐惧，因为社会规范倾向于对艾滋病毒和性风险保持沉默，还因为缺乏文化上合格的卫生服务。此外，HIV+ MSM/TW 面临着严重的 HIV 耻辱，这影响了 HIV 状况的披露、获得 HIV 检测和护理的意愿以及社会支持。需要采取多层次干预方法，解决个人、社会/社区和卫生系统层面的因素，以促进艾滋病毒感染的早期发现；将艾滋病病毒感染者联系起来、保留并重新让其接受护理和治疗，以实现病毒抑制；降低艾滋病毒感染者和艾滋病毒阳性者的性风险；围绕这些问题进行社区动员，为艾滋病毒预防和治疗提供支持并改变社会规范和参与。强调预防和护理连续体（CPC）中预防与护理联系的多层次方法可能会通过涉及社区和卫生设施的综合活动减少艾滋病毒预防和护理的障碍，同时在干预要素之间产生协同作用。我们开发并试行了 Proyecto Orgullo (PO)，这是一种基于理论的多层次干预措施，通过建立一个动员起来、赋权的 MSM/TW 社区来传播对艾滋病毒预防的支持并创造积极的社会规范，以减少不安全性行为并促进每年两次的艾滋病毒检测。 PO 已被证明是可以接受的、可行的并且具有潜在的有效性。我们现在建议与秘鲁卫生部 (MoH) 和当地医疗机构合作，开发、实施和测试 PO+ 的功效，PO+ 是 PO 的延伸，将促进全面参与 CPC，并加强社区与卫生系统之间的联系。如果效果显着，PO+ 可以在卫生部的支持下在整个秘鲁推广，并在包括美国在内的美洲其他地方用作模型。 该项目的目标是： (1) 创建 Proyecto Orgullo+ (PO+)，一项以 CPC 为重点的全面、综合、多层次的干预措施； (2) 与秘鲁卫生部、提供艾滋病毒护理的医院和艾滋病毒检测点合作，在利马南部实施 PO+ 3 年； (3) 使用以下内容评估 PO+ 对 CPC 的影响效果： (a) CPC 数据，包括性危险行为、HIV 检测频率；肛门衣原体和淋病的发病率以及 HIV+ 人群的护理参与度，通过利马南和利马东（对照区）的 MSM/TW 纵向队列收集，独立于干预措施招募，对 HIV+ MSM/TW 进行过采样； (b) 由卫生部收集和提供的 HIV 患者的 CD4 和 VL 数据。