Feasibility and Acceptability of an MI-based Telehealth Intervention for Bacterial STI Screening

项目总结/摘要 男同性恋、双性恋和其他与艾滋病毒感染者发生性关系的男子（GBMSM-LWH）承受着沉重的负担， 细菌性性传播感染，如淋病、衣原体和梅毒。左 未经治疗的细菌性性病可能导致严重的健康并发症。炎症性和溃疡性STI也可以 在病毒抑制不充分的情况下，促进艾滋病毒的进一步性传播。及时 诊断和治疗是预防的关键。从事艾滋病毒医疗护理的性活跃的GBMSM-LWH 未按建议至少每年进行GC、CT和梅毒筛查。家庭标本自采 在对不同人群进行的研究中，越来越多地用于筛查细菌性STI。远程医疗 在管理心理健康和提高抗逆转录病毒治疗依从性方面也显示出了希望， 艾滋病毒感染者。只有少数研究将家庭标本自我收集与现场音频/视频结合起来 (AV)所有这些会议都仅限于没有艾滋病毒的人。没有人关注GBMSM-LWH 或结合动机访谈（MI），一种以客户为中心，以优势为基础的咨询方法， 旨在支持个人积极的行为改变。整合家庭标本自我采集， 通过实时AV会议提供的MI可能暴露的不同解剖部位可能提供独特的 GBMSM-LWH参与细菌STI筛查的解决方案。MI引导的讨论有可能 提高参与者对细菌性性传播感染的认识，增强他们保护自己的内在动机， 他们的性伴侣，提高他们的自我效能的标本自我收集，并解决问题的障碍，以寻求 治疗（如有必要）和重复测试。我们的顺序解释性混合方法研究旨在探索 一种新的基于MI的远程健康干预性活跃GBMSM-LWH的可行性和可接受性。在 第一阶段，我们将通过移动的约会应用程序和社交网站招募75名参与者，并提供一个3- 组件干预：（i）测试前的实时AV会议会话，涉及MI引导的讨论， 提高对细菌性性传播感染的认识，填补任何知识空白，加强定期筛查的重要性 GC，CT和梅毒，并提高自我标本采集的自我效能，（ii）在家中自我采集， 寄回手指针刺血液样本（用于梅毒检测）、尿液样本（用于GC和CT检测）、 咽拭子（用于GC和CT检测）和直肠拭子（用于GC和CT检测），以及（iii）检测后活AV 会议会话，涉及MI引导的讨论，以使参与者为接收测试结果做好准备， 制定个性化的行动计划，寻求治疗（如有必要）和重复测试。在第二阶段，我们将 对有目的地选择的20名参与者进行深入访谈， 逐步减少检测前阶段的子集，细菌性传播感染检测的标本返回，以及检测后阶段 会议，以阐明与参与我们干预的每个组成部分有关的态度、促进者和障碍。

PROJECT SUMMARY/ABSTRACT Gay, bisexual and other men who have sex with men living with HIV (GBMSM-LWH) bear a heavy burden of bacterial sexually transmitted infections (STIs) such as gonorrhea (GC), chlamydia (CT) and syphilis. Left untreated, bacterial STIs may lead to serious health complications. Inflammatory and ulcerative STIs can also facilitate the onward sexual transmission of HIV in the presence of inadequate viral suppression. Timely diagnosis and treatment are key to prevention. Sexually active GBMSM-LWH engaged in HIV medical care are not being screened for GC, CT and syphilis at least annually, as recommended. Home specimen self-collection has increasingly been used to screen for bacterial STIs in studies conducted with diverse populations. Telehealth has also demonstrated promise in managing mental health and increasing antiretroviral therapy adherence in people living with HIV. Only few studies have combined home specimen self-collection with live audio/video (AV) conferencing, all of which have been restricted to people without HIV. None have focused on GBMSM-LWH or incorporated motivational interviewing (MI), a client-centered, strengths-based counseling approach that seeks to support individuals towards positive behavioral change. Integrating home specimen self-collection from different anatomical sites of possible exposure with MI delivered via live AV conferencing might offer a unique solution to engage GBMSM-LWH in bacterial STI screening. MI-guided discussions have the potential to increase participants’ knowledge of bacterial STIs, enhance their intrinsic motivation to protect themselves and their sex partners, improve their self-efficacy for specimen self-collection, and problem-solve barriers to seeking treatment (if warranted) and repeat testing. Our sequential explanatory mixed-methods study seeks to explore the feasibility and acceptability of a novel MI-based telehealth intervention for sexually active GBMSM-LWH. In Phase 1, we will recruit 75 participants via mobile dating apps and social networking websites, and deliver a 3- component intervention: (i) a pre-test live AV conferencing session involving an MI-guided discussion to elicit awareness of bacterial STIs and fill any knowledge gaps, bolster the perceived importance of regularly screening for GC, CT and syphilis, and improve self-efficacy for specimen self-collection, (ii) self-collecting at home and returning by mail a finger-stick blood sample (for syphilis testing), a urine sample (for GC and CT testing), a pharyngeal swab (for GC and CT testing) and a rectal swab (for GC and CT testing), and (iii) a post-test live AV conferencing session involving an MI-guided discussion to prepare participants for receiving test results and formulate personalized action plans for seeking treatment (if warranted) and repeat testing. In Phase 2, we will conduct in-depth interviews with a purposively selected subsample of 20 participants who complete progressively smaller subsets of the pre-test session, specimen return for bacterial STI testing, and the post-test session to elucidate attitudes, facilitators and barriers related to engaging in each component of our intervention.