Development and Feasibility Testing of a Multi-Component Intervention to Increase HIV Testing and Linkage to Services among MSM in Peru

总结/摘要 尽管免费抗逆转录病毒治疗的规模有所扩大，但男男性行为者中的艾滋病毒感染率仍然很低， (MSM)在秘鲁仍然很高。延迟诊断和与护理的次优联系是两个重要因素， 向前传输提高检测率和促进及时与艾滋病毒治疗挂钩的新战略 预防是非常必要的。基于场地的测试和移动的健康（mHealth）是两个很有前途的 这些战略可以通过减少秘鲁男男性行为者在护理方面遇到的主要障碍来应对这些挑战。 根据我们以前的工作，在利马的社交场所（如酒吧/迪斯科舞厅、公共广场）提供艾滋病毒检测， 可接受的，并确定与以前未确诊的艾滋病毒感染的男男性行为者。将其扩展到性场所 场所（SOPV：桑拿浴室，性俱乐部，小时酒店）可以接触到特别脆弱的MSM亚群， 包括那些没有通过诊所测试的人。基于场所的艾滋病毒检测的一个潜在陷阱是关联度低 在新诊断的HIV+患者中提供护理。WelTel是一个基于证据的移动健康平台， 非常适合通过调整其理论指导的双向信息传递方法来提供帮助，以支持与护理的联系， 预防-在SOPV进行艾滋病毒检测的男男性行为者中。在本提案中，我们将开发、完善和 对面向男男性行为者的多成分艾滋病毒检测和与服务相联系的干预措施进行可行性测试 在秘鲁，由两个核心组成部分组成：1）基于SOPV的艾滋病毒检测和2）“AppSalud”，一种新的量身定制的 应用WelTel，促进与艾滋病毒服务的联系。在AIM 1中，我们将使用 目标人群和主要利益攸关方，以指导干预措施的制定。在AIM 2中，我们将开发 AppSalud通过重新配置WelTel与新的定制内容，然后测试它与两种潜在的用户类型：（a） 男男性行为者，以及（B）利马艾滋病毒诊所的提供者（测试提供者界面）。在“mCFIR”的指导下，mHealth- 具体版本的实施研究综合框架（CFIR），我们将进行混合 方法分析，从以下角度探索AppSalud的潜在实施障碍和促进因素 MSM和供应商。在AIM 3中，我们将进行多组分干预（SOPV-）的可行性试验。 基于HIV检测加AppSalud），比较3种HIV检测形式：快速床旁检测（POCT）、家庭 基于自我检测（HBST）和基于诊所检测（RCBT）的转诊。由经验丰富的团队支持 国际艾滋病毒调查人员和美国和秘鲁的杰出机构，这些研究构成了 候选人职业发展计划的指导临床研究部分。与此并行 研究，候选人将继续在实施科学，定性/混合方法， 移动健康和干预试验，由一个多学科团队的专业知识，致力于导师指导， 每一个这些领域。K23奖促成的培训和指导研究将启动 候选人的职业生涯作为一个独立的调查准备实现他的长期目标，成为一个领先的 艾滋病毒研究人员制定循证战略，以优化全球艾滋病毒预防和护理。

SUMMARY/ABSTRACT Despite the scale-up of free antiretroviral treatment (ART), HIV incidence among men who have sex with men (MSM) in Perú remains high. Delayed diagnosis and suboptimal linkage to care are two important factors driving onward transmission. New strategies to increase rates of testing and promote timely linkage to HIV treatment and prevention are greatly needed. Venue-based testing and mobile health (mHealth) are two promising strategies that could address these challenges by mitigating key barriers to care experienced by MSM in Perú. Based on our previous work, offering HIV testing at social venues (e.g. bars/discos, public plazas) in Lima is acceptable and identifies MSM with previously undiagnosed HIV infection. Extending this to sex-on-premises venues (SOPVs: saunas, sex clubs, hourly hotels) could reach a particularly vulnerable sub-population of MSM, including those not reached by clinic-based testing. One potential pitfall of venue-based HIV testing is low linkage to care among newly diagnosed HIV+ individuals. WelTel is an evidence-based mHealth platform that may be well-suited to assist by adapting its theory-guided two-way messaging approach to support linkage to care – and prevention – among MSM reached for HIV testing at SOPVs. In this proposal we will develop, refine, and conduct feasibility testing of a multi-component HIV testing and linkage-to-services intervention for MSM in Perú, consisting of two core components: 1) SOPV-based HIV testing and 2) “AppSalud”, a novel tailored application of WelTel to facilitate linkage to HIV services. In AIM 1, we will conduct formative research with the target population and key stakeholders to guide development of the intervention. In AIM 2, we will develop AppSalud by reconfiguring WelTel with new tailored content, then beta test it with both potential user types: (a) MSM, and (b) providers at HIV clinics in Lima (to test the provider interface). Guided by the “mCFIR”, a mHealth- specific version of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed methods analysis exploring potential implementation barriers and facilitators for AppSalud from the perspectives of both MSM and providers. In AIM 3, we will conduct a feasibility trial of the multi-component intervention (SOPV- based HIV testing plus AppSalud), comparing 3 HIV testing formats: rapid point-of-care testing (POCT), home based self-testing (HBST), and referral for clinic-based testing (RCBT). Supported by a team of experienced international HIV investigators and outstanding institutions in both the U.S. and Perú, these studies constitute the mentored clinical research component of the candidate’s career development plan. In parallel with this research, the candidate will pursue additional training in implementation science, qualitative/mixed methods, mHealth, and intervention trials, guided by a multidisciplinary team of committed mentors with expertise in each of these areas. The training and mentored research made possible by this K23 Award will launch the candidate’s career as an independent investigator poised to achieve his long-term goal of becoming a leading HIV researcher developing evidence-based strategies to optimize HIV prevention and care globally.