Community Intervention for HIV Testing & Care Linkage Among Young MSM in Bulgaria

HIV 检测的社区干预

• 批准号: 9314611
• 负责人: Yuri A Amirkhanian
• 金额: $ 32.32万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-10 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9314611
• 关键词: 20 year old; AIDS prevention; AIDS/HIV problem; Address; Age; Alcohol or Other Drugs use; Attitude; Behavioral; Bulgaria; Caring; Case Management; Communities; Counseling; Country; Data; Democracy; Diagnosis; Disease; Early Diagnosis; Eastern Europe; Effectiveness; Enrollment; Epidemic; Ethnic Origin; Europe; Friends; Friendships; Fright; Gays; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Homosexuality; Human immunodeficiency virus test; Incidence; Infection; Influentials; Intervention; Intervention Trial; Interview; Link; Measures; Medical; Methods; Monitor; Outcome; Participant; Patient Self-Report; Perception; Persons; Phase; Provider; Public Health; Randomized; Recommendation; Recording of previous events; Recruitment Activity; Research; Risk; Risk Reduction; Seeds; Services; Sexual Transmission; Site; Social Network; Stigmatization; Testing; Training; Trust; antiretroviral therapy; base; community intervention; cost; experience; informant; intervention effect; low and middle-income countries; member; men; men who have sex with men; programs; public health relevance; same sex behavior; social; social stigma; theories; therapy design; uptake; young man; young men who have sex with men

 DESCRIPTION (provided by applicant): Throughout the world, young MSM are disproportionately burdened by HIV infection. Young MSM in low- and middle-income countries often do not seek out HIV testing, are unaware of their HIV-positive status, and do not receive early medical care, compromising their health and contributing to downstream disease incidence. This situation is of great concern in post-socialist countries of Eastern Europe, where stigma about HIV/AIDS and same-sex behavior are great, HIV epidemics are still increasing, and the health needs of young MSM are rarely acknowledged or addressed. The planned research will be conducted in Sofia, Bulgaria where MSM account for nearly half of HIV infections, MSM communities are very young, and a high proportion of persons living with HIV (PLH) are undiagnosed. This mixed-methods study will be conducted in two phases. In an initial qualitative phase, we will conduct in-depth interviews with young MSM ages 16 to 20 and other key informants to gain an understanding of factors related to HIV testing, as well as barriers and facilitators of testing and medical care. Results of the qualitative study will be shared with HIV test and care providers, and we will gain further input from a community advisory panel. The project's second phase is a trial of a network intervention to increase regular HIV testing and care linkage among young MSM. Our prior studies in Bulgaria have shown that young MSM are clustered with other young MSM in their social or friendship networks. The intervention trial will recruit 54 small social networks of MSM, each consisting of a young MSM "seed" between age 16 and 20 and also all close MSM friends surrounding the seed (expected n=54 networks x 5 members/network=270 participants). All participants will complete baseline measures assessing recent HIV testing practices and testing history; attitudes, intentions, perceived norms, barriers, and understanding about HIV testing and medical care; sexual risk practices; and substance use. All participants will receive HIV risk reduction counseling. Networks will then be randomized in equal numbers to comparison and intervention conditions. The influence leader of each experimental condition network will be empirically identified, and network leaders will together attend a 5-session intervention. Sessions will train, guide, and engage the cadre of leaders to deliver theory-based, personally-tailored advice and counseling to their network members to correct misconceptions about HIV testing and care; strengthen friends' norms, attitudes, intentions, and perceived benefits of regular testing; and address barriers to testing. All members of intervention and comparison condition networks will be re-assessed at 6- and 12-month followup to determine the intervention's effects on HIV testing, regular testing, and testing- and care-related scale measures. Data obtained from Sofia VCT providers will be used to corroborate testing uptake. Participants diagnosed with HIV infection at any point will be linked to medical care. If successful, this research will identify a new strategy for reaching and encouraging regular HIV testing in world regions where young MSM are often hidden in the community.

 描述（由申请人提供）：在世界各地，年轻的 MSM 受到 HIV 感染的负担尤为严重。低收入和中等收入国家的年轻男男性行为者往往不寻求艾滋病毒检测，不知道自己的艾滋病毒阳性状况，也不接受早期医疗护理，从而损害了他们的健康并导致下游疾病的发生。这种情况在东欧后社会主义国家引起了高度关注，这些国家对艾滋病毒/艾滋病和同性行为的耻辱感很大，艾滋病毒流行仍在增加，年轻男男性接触者的健康需求很少得到承认或解决。计划中的研究将在保加利亚索非亚进行，那里的 MSM 占 HIV 感染者的近一半，MSM 社区非常年轻，而且很大一部分 HIV 感染者 (PLH) 未被诊断。这项混合方法研究将分两个阶段进行。在最初的定性阶段，我们将对16至20岁的年轻MSM和其他关键知情人进行深入访谈，以了解与HIV检测相关的因素，以及检测和医疗护理的障碍和促进因素。定性研究的结果将与艾滋病毒检测和护理提供者分享，我们将从社区咨询小组获得进一步的意见。该项目的第二阶段是网络干预试验，以加强年轻男男性接触者之间的定期艾滋病毒检测和护理联系。我们之前在保加利亚的研究表明，年轻的男男性行为者在他们的社交或友谊网络中与其他年轻的男男性行为者聚集在一起。干预试验将招募 54 个 MSM 小型社交网络，每个网络由 16 岁至 20 岁之间的年轻 MSM“种子”以及种子周围的所有 MSM 亲密朋友组成（预计 n=54 个网络 x 5 个成员/网络=270 名参与者）。所有参与者将完成基线测量，评估最近的艾滋病毒检测实践和检测历史；态度、意图、感知规范、障碍、 以及对艾滋病毒检测和医疗保健的了解；性风险行为；和物质使用。所有参与者都将接受降低艾滋病毒风险咨询。然后，网络将被随机分配为相同数量的比较和干预条件。每个实验条件网络的影响力领导者将根据经验确定，网络领导者将共同参加为期 5 次的干预。会议将培训、指导和吸引领导干部，向其网络成员提供基于理论、量身定制的建议和咨询，以纠正对艾滋病毒检测和护理的误解；强化朋友的规范、态度、意图和定期测试的好处；并解决测试障碍。干预和比较条件网络的所有成员将在 6 个月和 12 个月的随访中重新评估，以确定干预措施对 HIV 检测、定期检测以及检测和护理相关规模测量的影响。从索非亚 VCT 提供商获得的数据将用于证实测试的采用情况。任何时候被诊断出感染艾滋病毒的参与者都将获得医疗护理。如果成功，这项研究将确定一种新策略，以在年轻男男性接触者经常隐藏在社区中的世界地区实现并鼓励定期进行艾滋病毒检测。