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

摘要 PREP是一种强大的、可能具有开创性的艾滋病毒预防战略，但其对公共卫生的影响 将取决于感染艾滋病毒感染风险最大的人的大规模收养。备考意识 而在中部中等城市的非裔美国男男性接触者中，使用率仍然特别低 国家，而且很少有研究测试可以提高PrEP意识、受益的干预措施 在非裔美国MSM中的认知和规范支持--并减少PrEP污名和担忧 在这些城市。PREP只有在少数族裔中得到普及，才能充分发挥其公共卫生潜力 在被忽视的美国中等城市，男男性接触者正在增加。在之前的研究中，我们的团队确定了 网络级别的干预措施可以达到并用于向Black提供有效的艾滋病毒风险降低干预措施 中西部工业地区的男男性接触者，包括隐藏在社区中的难以接触到的人。计划中的混合- 方法研究现在将评估一项网络干预，以增加非洲高危人群中PrEP的摄入量 密尔沃基和克利夫兰的美国男男性接触者，这两个城市的艾滋病毒种族差异很大，但PrEP的使用率很高 很低。在形成研究阶段，将对非裔美国MSM(PrEP)进行深入访谈 提供商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 PrEP使用率。在主要干预试验阶段，对36名社会网络高危少数民族男男性行为者进行干预 (预计n=504名参与者)将通过招募高风险的初始“种子”，每个城市18个网络， 每个种子的MSM友谊网络的成员，然后向外连续两圈他们的朋友。全 研究参与者将接受PrEP和降低风险的基线咨询。届时，这36个网络将成为 在干预和比较条件下随机进行相同数量的研究。在每种干预条件下 网络，一支对PrEP持开放态度、接受建议并与其他人高度互联的网络领导者干部将 参加一项干预活动，在向朋友传播信息方面进行教育，然后提供培训和指导 鼓励采用PrEP，纠正PrEP的误解和耻辱，并灌输积极的PrEP规范和 受益观感。在基线和6个月和15个月的随访点，参与者将完成 替诺福韦干血斑样本的测试证实了PREP的使用；与PrEP相关的措施 知识、态度、感知的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HIV参与者更多地采用PrEP 比在比较网络中发现的要多。准备知识、态度、意图、同伴规范和阶段 改革准备情况将作为调解人和次要成果进行探讨。对艾滋病病毒的干预效果 将对发病率进行数学建模，以确定其对公共健康的影响。这项研究将检验一部小说 在美国中等城市被忽视的少数族裔男男性行为者中增加PrEP使用量的方法 最好的--也许只能通过他们的社交网络联系到--。

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.