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

 描述(由申请人提供)：在世界各地，年轻的MSM感染艾滋病毒的负担不成比例。低收入和中等收入国家的年轻男男性接触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态，也没有得到早期医疗护理，损害了他们的健康，并助长了下游疾病的发病率。这种情况在东欧的后社会主义国家非常令人担忧，这些国家对艾滋病毒/艾滋病和同性行为的耻辱很大，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，那里的男男性接触者占艾滋病毒感染的近一半，男男性接触者社区非常年轻，艾滋病毒携带者(PLH)中有很高比例的人没有得到诊断。这项混合方法研究将分两个阶段进行。在初步的定性阶段，我们将深入访谈16至20岁的年轻男男性接触者和其他主要信息者，以了解与艾滋病毒检测有关的因素，以及检测和医疗保健的障碍和促进者。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的试验，以增加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MSM在他们的社交或友谊网络中与其他年轻的MSM聚集在一起。干预试验将招募54个MSM的小型社交网络，每个网络由一个16岁至20岁的年轻MSM“种子”以及种子周围所有亲密的MSM朋友组成(预计n=54个网络x 5个成员/网络=270名参与者)。所有参与者将完成评估最近艾滋病毒检测做法和检测历史的基线测量；态度、意图、感知的规范、障碍、 以及对艾滋病毒检测和医疗保健；性风险做法；以及物质使用的了解。所有参与者都将接受艾滋病毒风险降低咨询。然后，网络将被随机分配到相同数量的比较和干预条件下。每个实验条件网络的影响领导者将被经验地确定，网络领导者将一起参加为期5个会议的干预。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的、个人量身定做的建议和咨询，以纠正对艾滋病毒检测和护理的误解；加强朋友的规范、态度、意图和定期检测的预期好处；并解决检测障碍。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，以确定干预对艾滋病毒检测、定期检测以及检测和护理相关量表测量的影响。从索非亚VCT供应商那里获得的数据将被用来证实测试吸收情况。在任何时候被诊断出感染艾滋病毒的参与者都将被联系到医疗护理。如果成功，这项研究将确定一种新的战略，在年轻MSM经常隐藏在社区中的世界地区实现和鼓励定期艾滋病毒检测。

 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.