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Increasing PrEP Use in High-Risk Social Networks of African American MSM in Underserved Low-Uptake Cities

在服务不足、使用率低的城市中，增加非洲裔美国男男性接触者高风险社交网络中 PrEP 的使用

基本信息

批准号：
10200891
负责人：
Yuri A Amirkhanian
金额：
$ 66.05万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-21 至 2023-06-30
项目状态：
已结题

项目摘要

Abstract PrEP is a powerful and potentially groundbreaking HIV prevention strategy, but its public health impact will depend on widescale adoption by persons at greatest risk for contracting HIV infection. PrEP awareness and use remain especially low among African American MSM in mid-sized cities across the center of the country, and very little research has tested interventions that can increase PrEP awareness, benefit perception, and normative support—and decrease PrEP stigma and concerns—among African American MSM in these cities. PrEP can achieve its full public health potential only when its uptake among racial minority MSM in neglected mid-sized American cities is increased. In prior research, our team established that network-level interventions can reach and be used to deliver effective HIV risk reduction interventions to Black MSM in the industrial Midwest, including hard-to-reach men hidden in the community. The planned mixed- methods research will now evaluate a network intervention to increase PrEP uptake among high-risk African American MSM in Milwaukee and Cleveland, cities where HIV racial disparities are profound but PrEP use is low. In a formative research phase, in-depth interviews will be conducted with African American MSM, PrEP providers, and other key informants in each city to identify understandings, concerns, barriers, and facilitators of PrEP use. In the main intervention trial phase, 36 social networks of high-risk racial minority MSM (expected n=504 participants) will be enrolled, 18 networks per city, by recruiting high-risk initial “seeds,” members of each seed's MSM friendship network, and then two outward successive rings of their friends. All study participants will receive baseline counseling for PrEP and risk reduction. The 36 networks will then be randomized in equal numbers to intervention and comparison conditions. In each intervention condition network, a cadre of network leaders open to PrEP, trusted for advice, and highly interconnected with others will attend an intervention that educates and then provides training and guidance in diffusing messages to friends to encourage PrEP uptake, correcting PrEP misconceptions and stigma, and instilling positive PrEP norms and benefit perceptions. At baseline and 6- and 15-month followup points, participants will complete measures of PrEP use corroborated by the testing of dried blood spot specimens for tenofovir; measures of PrEP related knowledge, attitudes, perceived norms, and stage of change readiness; sexual risk practices; and substance use. We hypothesize that the network intervention will produce greater PrEP adoption by HIV- participants than that found in comparison networks. PrEP knowledge, attitudes, intentions, peer norms, and stage of change readiness will be explored as both mediators and as secondary outcomes. Intervention effects on HIV incidence will be mathematically modeled to determine its public health impact. This research will test a novel approach for increasing PrEP use among neglected racial minority MSM in mid-sized American cities who can best—and can perhaps only—be reached through their social network connections.

摘要 PrEP是一种强大且具有潜在突破性的艾滋病毒预防策略，但其公共卫生影响将取决于最有可能感染艾滋病毒的人的大规模收养。PrEP意识在美国中部的中型城市，非洲裔美国人的MSM使用率特别低，很少有研究测试了可以提高PrEP意识，认知和规范性支持-并减少非裔美国人MSM之间的PrEP耻辱和担忧在这些城市。PrEP只有在少数种族中被吸收时，才能充分发挥其公共卫生潜力被忽视的美国中等城市的MSM人数增加。在之前的研究中，我们的团队确定，网络层面的干预措施可以覆盖并用于向黑人提供有效的降低艾滋病毒风险的干预措施中西部工业区的男男性接触者，包括隐藏在社区中难以接触的男性。计划中的混合- 方法研究现在将评估网络干预，以增加高风险非洲人的PrEP吸收密尔沃基和克利夫兰的美国男男性接触者，这些城市的艾滋病毒种族差异很大，但PrEP的使用低在形成性研究阶段，将与非裔美国男男性接触者进行深入访谈，提供者和每个城市的其他关键信息提供者，以确定理解，关注，障碍和促进者使用PrEP。在主要干预试验阶段，36个社交网络的高危少数民族男男性接触者（预计n=504名参与者）将通过招募高风险初始“种子”，每个种子的MSM友谊网络的成员，然后是他们的朋友的两个向外连续的环。所有研究参与者将接受PrEP和降低风险的基线咨询。届时，36个网络将将相同数量的受试者随机分配至干预组和对照组。在每个干预条件下网络，一个网络领导干部开放的准备，值得信赖的建议，并与他人高度互连将参加一个干预活动，教育，然后提供培训和指导，在传播信息给朋友鼓励PrEP吸收，纠正PrEP误解和污名，并灌输积极的PrEP规范，利益观念。在基线以及6个月和15个月的随访时间点，参与者将完成以下测量：通过替诺福韦干血斑标本的测试证实了PrEP的使用; PrEP相关措施知识、态度、认知规范和变革准备阶段;性风险实践;以及实质内容使用.我们假设网络干预将使艾滋病毒参与者更多地采用PrEP 比在比较网络中发现的要多。PrEP知识，态度，意图，同伴规范和阶段将探讨变革准备情况，将其作为中介和次要成果。对艾滋病毒的干预效果将对发病率进行数学建模，以确定其对公共卫生的影响。这项研究将测试一本小说在美国中型城市被忽视的少数种族MSM中增加PrEP使用的方法，最好的，也许只能通过他们的社会网络联系。