Integrated online-to-offline (O2O) model of care for HIV prevention and treatment among men who have sex with men

男男性行为者艾滋病预防和治疗的线上线下（O2O）一体化护理模式

• 批准号: 10548402
• 负责人: Roman Shrestha
• 金额: $ 26.09万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548402
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Amphetamines; Attitude; Capital; Caring; Cellular Phone; Clinic; Collaborations; Communication; Communications Media; Communities; Continuity of Patient Care; Counseling; Country; Development; Diagnostic Reagent Kits; Discrimination; Drug usage; Environment; Epidemic; Face; Focus Groups; Fostering; Fright; Guidelines; HIV; HIV/STD; Harm Reduction; Health; Health Personnel; Health Technology; Health care facility; Homosexuality; Hour; Human immunodeficiency virus test; Hybrids; Incidence; Income; Individual; Intervention; Knowledge; Laws; Malaysia; Malaysian; Medical; Mental Depression; Mental disorders; Modeling; Motivation; Muslim population group; Online Systems; Pre-Post Tests; Prevalence; Process; Professional counselor; Psychotropic Drugs; Research; Risk Behaviors; Services; Sexual Partners; Sexual Transmission; Sexuality; Stigmatization; Stimulant; Tablets; Technology; Testing; Time; Unsafe Sex; Wait Time; World Health Organization; acceptability and feasibility; antiretroviral therapy; base; clinical care; cost effective; distrust; eHealth; empowered; experience; high risk; high risk behavior; high risk men; implementation determinants; implementation science; improved; innovation; insight; laptop; marginalized population; men; men who have sex with men; novel strategies; pilot test; pre-exposure prophylaxis; preference; prevention service; prototype; scale up; self testing; service delivery; sex; sexual encounter; social; social stigma; stem; substance use; syndemic; tool; transmission process; treatment as usual; treatment services; usability; willingness

Abstract Malaysia's HIV epidemic is rapidly expanding, with recent evidence suggesting increasing sexual transmission, especially in MSM. HIV prevalence among MSM is now at an all-time high of 21.6% and is concentrated in the country's capital, Kuala Lumpur, where prevalence among MSM is 43% in 2020, up from 22% just four years before. Insights into Malaysia's expanding HIV epidemic are multi-factorial: Both homosexuality and substance use are criminalized in Malaysia. MSM are, therefore, often hesitant to disclose their sexuality or risk behaviors, primarily due to fear of stigma, discrimination, or criminalization. Further, evidence suggests the widespread use (24%) of psychoactive substances (e.g., amphetamine-type stimulants) before or during a sexual encounter, also known as sexualized drug use (chemsex) among Malaysian MSM, which leads to high-risk sexual practices (e.g., condomless sex). Stigma and discrimination are also enacted on MSM by healthcare providers, which foster a hostile environment toward MSM, complicating efforts to scale-up of HIV testing and subsequent linkage to HIV prevention (pre-exposure prophylaxis) and treatment (antiretroviral therapy) services. HIV testing jumpstarts entry into the HIV prevention and treatment cascades. New HIV testing guidelines recommend MSM test every 3 to 6 months, as early HIV testing is a cost-effective strategy for stemming the HIV epidemic. Yet, HIV testing rates remain low among Malaysian MSM: ever tested (70.3%) and last year tested (30.9%). HIV self- testing (HIVST) may be particularly impactful among MSM in Malaysia. Although willingness to use HIVST is high in this group, its use is still minimal due to lack of access to HIVST kits, concerns related to misinterpreting results, and missed opportunities for counseling and linkage to care. In this context, eHealth represents an innovative platform to transform the face of HIV service delivery (i.e., testing and linkage to care). Leveraging eHealth platforms for HIV services delivery in Malaysia is ideal given that nearly all (>99%) MSM use some form of communication technology (e.g., smartphone, laptop) and has a strong preference for web-based platforms for HIVST. Therefore, we developed and pilot-tested a web-based HIVST platform, called Jom-Test®, to promote HIV testing by providing free anonymous HIVST. The results demonstrated high feasibility and acceptability for the platform but low post-test linkage to treatment and prevention services. The findings further indicated the need for real-time (online) access to counselors for pre- and post-test counseling and support for linkage to HIV and chemsex-related harm reduction services (offline). To address this evidence gap, we propose to jump-start the broader HIV care continuum by adapting, expanding, and refining an existing Jom-Test® platform. The enhanced version, to be called Jom-TestPlus, will include real-time e-counseling (eHIVST) with integrated O2O linkage to HIV prevention and treatment services while simultaneously co-addressing chemsex-related needs for Malaysian MSM. This model represents a potentially impactful strategy for reaching marginalized populations, like MSM, and allows immediate engagement in the post-test linkage process to prevention or treatment services.

摘要 马来西亚的艾滋病毒疫情正在迅速扩大，最近的证据表明，性传播正在增加， 尤其是在男男性接触者中。男男性接触者中的艾滋病毒流行率目前达到21.6%的历史最高水平，并集中在 该国首都吉隆坡，男男性接触者的流行率从短短四年的22%上升到2020年的43% 在此之前。对马来西亚日益扩大的艾滋病毒流行的洞察是多因素的：既有同性恋，也有实质内容 在马来西亚，使用大麻被定为犯罪。因此，男男性接触者在披露他们的性取向或危险行为时往往犹豫不决， 主要是由于对污名、歧视或刑事化的恐惧。此外，有证据表明， 性行为前或性行为期间使用精神活性物质(如苯丙胺类兴奋剂)的比例为24%， 在马来西亚男男性接触者中也被称为性行为(化学性)，这会导致高风险的性行为 (例如，无套公寓的性行为)。医疗保健提供者也对男男性接触者实施污名和歧视，这助长了 对男男性接触者怀有敌意的环境，使扩大艾滋病毒检测和随后与 艾滋病毒预防(暴露前预防)和治疗(抗逆转录病毒治疗)服务。艾滋病毒检测 迅速进入艾滋病毒预防和治疗的级联。新的艾滋病毒检测指南推荐男男性接触者 每3至6个月进行一次艾滋病毒检测，因为早期艾滋病毒检测是遏制艾滋病毒流行的一种具有成本效益的战略。然而， 马来西亚男男性接触者的艾滋病毒检测率仍然很低：曾经检测过(70.3%)，去年检测过(30.9%)。艾滋病病毒自我- 检测(HIVST)可能对马来西亚的男男性接触者特别有影响。尽管使用HIVST的意愿是 在这一群体中排名靠前的是，由于无法获得HIVST试剂盒，它的使用仍然很少，与误解有关的担忧 结果，并错过了咨询和联系护理的机会。在这种情况下，eHealth代表一种 创新平台，改变艾滋病毒服务提供的面貌(即检测和与护理的联系)。利用 在马来西亚提供艾滋病毒服务的电子健康平台是理想的，因为几乎所有(99%)MSM都使用某种形式 熟悉通信技术(如智能手机、笔记本电脑)，并对基于网络的平台有强烈的偏好 为了HIVST。因此，我们开发并试运行了一个基于Web的HIVST平台，名为JOM-Test®，以促进 通过提供免费匿名HIVST进行艾滋病毒检测。结果表明，该方法具有较高的可行性和可接受性。 该平台但检测后联动性低，以治疗和预防服务为主。调查结果进一步表明， 需要实时(在线)接触咨询人员，进行检测前和检测后的咨询，并支持与艾滋病毒的联系 和与化学性有关的减少伤害服务(离线)。为了解决这一证据差距，我们建议启动 通过调整、扩展和改进现有的Jom-Test®平台，实现更广泛的艾滋病毒护理连续性。这个 增强版将被称为JOM-TestPlus，将包括集成O2O的实时电子咨询(EHIVST) 与艾滋病毒预防和治疗服务相联系，同时共同解决与化学性有关的需求 马来西亚男男性接触者。这一模式代表了一种接触边缘人群的潜在影响战略， 像男男性接触者一样，并允许立即参与检测后与预防或治疗服务的联系过程。