Building mobile HIV prevention and mental health support in low-resource settings

在资源匮乏的地区建立流动艾滋病毒预防和心理健康支持

• 批准号: 10204911
• 负责人: Corina Lelutiu-Weinberger
• 金额: $ 75.16万
• 依托单位: RBHS-SCHOOL OF NURSING
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10204911
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; Alcohol abuse; Alcohol consumption; Appalachian Region; Area; Attention; Automobile Driving; Behavior Therapy; Behavioral; Biological; Bisexual; Bypass; Cognitive; Collaborations; Communities; Conscious; Country; Dangerousness; Data; Discrimination; Eastern Europe; Education; Ensure; Epidemic; Europe; European; European Union; Evaluation; Face; Future; Gays; HIV; HIV Infections; HIV Seropositivity; HIV risk; HIV/STD; Health; Health Personnel; Health Services; Healthcare; High Prevalence; Homophobia; Income; Infection; International; Intervention; Interview; Investments; Knowledge; Learning Module; Locales; Mediating; Mental Depression; Mental Health; Minority; Modeling; Motivation; Nature; Nongovernmental Organizations; Outcome Measure; Persons; Phase; Plant Roots; Population; Prevalence; Prevention; Preventive service; Professional counselor; Provider; Randomized; Randomized Controlled Trials; Reporting; Research; Resources; Risk; Romania; Route; Rural Appalachia; STI prevention; Sampling; Self Administration; Self Efficacy; Services; Site; Stress; Symptoms; Testing; Training; Translating; Travel; Treatment Efficacy; United States National Institutes of Health; Vulnerable Populations; alcohol testing; attentional control; base; comparison intervention; condomless anal sex; condoms; coping mechanism; cost; cost effective; cost effectiveness; cost estimate; design; efficacy testing; follow-up; high risk population; improved; mHealth; male; male health; member; men; men who have sex with men; motivational enhancement therapy; physical conditioning; pre-exposure prophylaxis; prevent; prevention service; primary outcome; psychosocial; recruit; response; screening; secondary outcome; self esteem; sex; skills; skills training; social stigma; stem; theories; tool; transmission process; treatment as usual

Project Summary This project is designed to remedy unaddressed and interlocking HIV-prevention and mental health needs among gay and bisexual men (GBM) in the Central Eastern European country of Romania, and their underpinning stigma-related mechanisms. Rampant stigma contributes to the increasing prevalence of HIV among Romanian GBM (from under 10% in 2009 to close to 20% in 2014, by best available estimates) and keeps GBM out-of-reach of HIV-prevention services. Our mHealth pilot intervention (titled “Despre Mine. Despre Noi.” [DMDN] translated as “About Me. About Us.”), which reduced US and Romanian GBM’s risk for HIV infection while also reducing depression and alcohol abuse in initial pre-post trials, is now ready for testing in a randomized controlled trial with a large national sample. The DMDN intervention entails eight 60-minute live chat sessions delivered by trained counselors on our mobile study platform using motivational interviewing (MI) and cognitive-behavioral skills training (CBST). First, during pre-trial (mos 1-5), in collaboration with a community advisory board consisting of GBM community members, GBM-affirmative physical and mental health providers, and our technical developer, we will fine-tune the DMDN intervention based on our pilot findings and evaluation interviews, and expand the original DMDN education materials for an education attention condition (EAC) that will serve as our control. Second, during the intervention phase (mos 6-45), we will recruit, screen, assess, and randomize GBM at risk for HIV infection and alcohol abuse to either the DMDN intervention (n=163) or EAC (n=163). The conditions are content matched, and both are hosted on our study platform. While DMDN will consist of eight weekly mHealth live chat sessions, EAC will consist of eight self- administered educational modules. Third, during the follow-up phase (mos 8-55), we will assess at 4, 8, and 12 months post-baseline, in a mobile fashion identical to the baseline, the primary outcome of condomless anal sex with male partners and secondary outcomes of alcohol abuse, depression, biologic HIV/STI infection, HIV/STI testing, and psychosocial mechanisms rooted in the Information-Motivation-Behavioral Skills (IMB) model (e.g., HIV/STI knowledge, condom use self-efficacy) and minority stress theory (e.g., identity concealment, internalized homophobia). We hypothesize that 1) compared to GBM randomized to EAC, those randomized to the mHealth DMDN condition will report significant reductions in condomless anal sex across the 12-month follow-up, 2) IMB and minority stress mechanisms will statistically mediate intervention efficacy, and 3) compared to EAC, the DMDN intervention will prove cost-effective in terms of HIV infections averted and reduced depression and alcohol abuse. If efficacious and cost-effective, DMDN presents a highly disseminable intervention that could significantly prevent HIV infection among GBM in high-stigma, low- resource areas, where GBM are disproportionately affected by HIV, yet kept out-of-reach of brick-and-mortar prevention services.

项目摘要 该项目旨在解决尚未解决和相互关联的艾滋病毒预防和心理健康需求 在中东欧国家罗马尼亚的同性恋和双性恋男性（GBM）中， 支持与污名相关的机制。猖獗的污名化助长了艾滋病毒的日益流行 罗马尼亚GBM（根据现有最佳估计，从2009年的不到10%增加到2014年的近20%）， 使GBM无法获得艾滋病预防服务。我们的移动健康试点干预（题为“Despre Mine. “绝望之夜”[DMDN]翻译为“关于我。关于我们。”），这降低了美国和罗马尼亚GBM的风险， 艾滋病毒感染，同时也减少抑郁症和酒精滥用在最初的前后试验，现在准备测试 在一个大样本的随机对照试验中。DMDN干预需要8个60分钟的 由经过培训的辅导员在我们的移动的学习平台上使用动机访谈进行实时聊天 (MI)认知行为技能训练（CBST）首先，在预审期间（第1-5个月），与 由GBM社区成员组成的社区咨询委员会，GBM肯定的身体和精神 医疗服务提供者和我们的技术开发人员，我们将根据我们的试点微调DMDN干预 调查结果和评估访谈，并扩大原来的DMDN教育材料的教育 注意条件（EAC），将作为我们的控制。第二，在干预阶段（第6-45个月），我们 将招募、筛选、评估和随机分配有HIV感染和酗酒风险的GBM， 干预（n=163）或EAC（n=163）。条件是内容匹配的，两者都托管在我们的研究中 平台虽然DMDN将包括八个每周mHealth实时聊天会话，EAC将包括八个自我- 管理的教育模块。第三，在随访阶段（mos 8-55），我们将在4、8和12时进行评估 基线后3个月，以与基线相同的移动的方式，无避孕套肛门的主要结局 与男性伴侣发生性关系以及酗酒、抑郁、生物艾滋病毒/性传播感染的次要结局， 艾滋病毒/性传播感染检测和植根于信息-动机-行为技能的心理社会机制 模型（例如，艾滋病毒/性传播感染知识、避孕套使用自我效能）和少数群体压力理论（例如，身份 隐藏，内化同性恋恐惧症）。我们假设1）与随机分配至EAC的GBM相比， 随机分配到mHealth DMDN条件将报告无安全套肛交的显着减少， 12个月随访，2）IMB和少数应激机制将在统计学上介导干预效果， 3）与EAC相比，DMDN干预在避免艾滋病毒感染方面将证明具有成本效益 减少抑郁和酗酒。如果有效和具有成本效益，DMDN呈现出高度的 可传播的干预措施，可以显着防止艾滋病毒感染的GBM在高耻辱，低， 资源地区，GBM受艾滋病毒影响不成比例，但却远离实体经济 预防服务。