Integration of Electronic SBI(RT) into an HIV Testing Program to Reduce Substance Use and HIV risk Behavior among MSM in Argentina

在美国，男男性行为者(MSM)不成比例地受到艾滋病毒和药物滥用的影响， 欧洲和拉丁美洲。然而，正如在普通人群中一样，识别和接触MSM与 将有问题的物质使用(PSU)纳入治疗是一个重大挑战，这导致了绝大多数 患有多发性硬化症的男男性接触者从未接受治疗。药物滥用和精神健康服务管理局 (SAMHSA)建议筛查(S)、短暂干预(BI)和转诊治疗(RT；SBIRT)作为一种 对不寻求治疗的有危险饮酒和吸毒的个人进行早期干预，并及时 转介给那些有药物使用障碍的人进行更密集的药物滥用治疗。对这样的需求 干预在阿根廷和拉丁美洲尤其严重，在这两个国家几乎没有实施 对MSM伴发PSU的循证干预。拟议的研究试图通过以下方式解决这一明显的差距 为等待Nexo协会艾滋病毒检测的MSM制定和试行电子SBI计划 我们在布宜诺斯艾利斯的社区合作伙伴。基于平板电脑的e-SBI将把物质使用和性行为结合起来 风险行为筛查员和作为BI的个性化动机访谈(MI)。我们还将适应和 试行青年男子健康项目(YMHP，现为MHP)，因为该项目将不局限于年轻人 MSM)，这是一种基于四次MI的干预措施，有效地减少了药物使用和无套肛门 物质之间的性行为使用MSM，作为Nexo为中度患者参与者提供的一种简短治疗 或高风险物质的使用。这项R34研究的具体目标是：1)开发一种量身定做的e-SBI干预 对男男性接触者进行艾滋病毒检测，目的是减少药物使用和艾滋病毒危险行为(主要)；2)评估 将电子履行机构纳入Nexo艾滋病毒检测过程的可行性和可接受性，由a衡量) Nexo的MSM测试客户接受进入研究的百分比；b)完成研究的参与者的百分比 电子履行机构；c)电子履行机构可接受性评级(初级)；3)评估实施适应方案的可行性和可接受性 Nexo的YMHP，以a)有中等或高风险物质使用的MSM进入的百分比衡量 和/或完成医疗保险计划；b)接受医疗保险计划的人对医疗保险计划的接受度；c)会议百分比 由每个符合MI保真度标准(二级)的MHP顾问进行。在阶段1(开发)中，我们 将开发e-SBI，将YMHP改造为MHP，培训MHP顾问，并与50名MSM进入Nexo进行e-SBI试点 用于艾滋病毒检测。在第二阶段(随机对照试验)，我们将以3：1的比例随机抽取200名来Nexo进行艾滋病毒检测的MSM (ESBI：仅筛选评估-SA)，以评估在即将到来的MSM中使用e-SBI的可行性和可接受性 将Nexo用于艾滋病毒检测，并建立和试点随机对照试验程序，用于未来的试验。作为次要目标，我们将 评估将MHP提供给具有低或中等风险物质的参与者的接受度、可接受性和可行性 在有高危药物使用或药物滥用风险的参与者中使用和随后转诊至药物滥用治疗 依赖。最后，我们将探索关于药物使用和降低性风险结果的初步结果。

Men who have sex with men (MSM) are disproportionally affected by HIV and substance abuse in the U.S., Europe, and Latin America. However, as in the general population, identifying and engaging MSM with problematic substance use (PSU) into treatment is a significant challenge, which results in the great majority of MSM with PSU never receiving treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends Screening (S), Brief Intervention (BI), and Referral to Treatment (RT; SBIRT) as an early intervention for non-treatment-seeking individuals with risky alcohol and drug use, as well as the timely referral to more intensive substance abuse treatment for those with substance use disorders. The need for such an intervention is particularly acute in Argentina and Latin America, where there is little implementation of evidence-based interventions for MSM with PSU. The proposed study seeks to address this glaring gap by developing and piloting an electronic-SBI program tailored for MSM awaiting their HIV test at Nexo Asociacion Civil, our community partners in Buenos Aires. The tablet-based e-SBI will integrate substance use and sexual risk behavior screeners and individually tailored Motivational Interviewing (MI) as the BI. We will also adapt and pilot the implementation of the Young Men’s Health Project (YMHP, now MHP since it will not be limited to young MSM), a four-session MI-based intervention that effectively reduced substance use and condomless anal intercourse among substance using MSM, as a brief treatment provided at Nexo for participants with moderate or high-risk substance use. The Specific Aims of this R34 study are to: 1) develop a tailored e-SBI intervention for MSM in an HIV testing context aimed at reducing substance use and HIV risk behavior (Primary); 2) assess the feasibility and acceptability of integrating e-SBI into the HIV testing process at Nexo as measured by a) percent of MSM testing clients at Nexo who accept entry into the study; b) percent of participants who complete e-SBI; c) e-SBI acceptability ratings (Primary); 3) assess the feasibility and acceptability of implementing adapted YMHP at Nexo, as measured by a) the percent of MSM with moderate or high-risk substance use who enter and/or complete MHP; b) acceptability of MHP among those who received it; and c) percentage of sessions conducted by each MHP counselor that meets criteria for MI fidelity (Secondary). In Stage 1 (Development) we will develop e-SBI, adapt YMHP into MHP, train MHP counselors, and pilot e-SBI with 50 MSM coming to Nexo for HIV testing. In Stage 2 (RCT Pilot), we will randomize 200 MSM coming to Nexo for HIV testing at a 3:1 ratio (eSBI: Screening Assessments Only-SA) to assess the feasibility and acceptability of e-SBI among MSM coming to Nexo for HIV testing and establish and pilot the RCT process for a future trial. As a secondary aim, we will assess uptake, acceptability, and feasibility of delivering MHP to participants with low or moderate risk substance use and subsequent referrals to substance abuse treatment among participants with high-risk substance use or dependence. Lastly, we will explore preliminary findings on substance use and sexual risk reduction outcomes.