Increasing HIV/STI Home Testing, Linkage toCare, and Linkage to PrEP via a Digital Intervention among Black Women in a GeographicHotspot

项目概要：在德克萨斯州特拉维斯县，由于艾滋病毒感染率高，被认为是艾滋病毒的地理热点， 黑人妇女感染艾滋病毒的可能性是其他种族/族裔妇女的18.4倍。黑色 女性也比其他女性有更高的性传播感染率;许多性传播感染者没有 症状，未确诊，未经治疗。患有性传播感染会使感染艾滋病毒的风险增加三倍。在特拉维斯 县，超过20%的妇女在感染艾滋病毒一年后得知她们是艾滋病毒阳性， 测试的障碍。家庭艾滋病毒/性传播感染检测有希望通过绕过障碍提高检测率， 从而通过早期检测和护理降低医疗成本。家庭艾滋病毒/性传播感染检测也是 有机会将艾滋病毒高危黑人妇女与暴露前预防（PrEP）联系起来。然而，家庭测试 光靠自己并不能克服所有的障碍。将家庭测试与旨在增加动机的干预措施配对 最有希望提高艾滋病毒/性传播感染检测率。拟议项目借鉴了 3个组成部分，情境，信息-动机-行为（sIMB）模型，心理对比， 执行意图是制定一项新的、基于网络的干预措施。本次活动由5个 会议：1）使用艾滋病毒/性传播感染家庭检测试剂盒，2）邮寄试剂盒，3）检查结果，4）获得治疗， 和5）参加PrEP预约。每次会议的结构都是相同的：有关 每个行为的重要性（即，采取家庭测试，邮寄测试，检查结果，联系护理， 以及与PrEP的联系），通过心理对比的动机（确定积极的结果和障碍， 会议）和方法，以克服所确定的障碍（实施意图），以及行为技能， 提高自我效能。该项目将分三个阶段进行，与发展和文化的目标相吻合。 调整干预措施。1)进行形成性研究以制定干预措施。四个焦点组（n=4-6）， 来自特拉维斯县的24名黑人妇女将探讨sIMB的结构，心理对比， 执行意图是制定干预协议，以便在目标2中进行实地测试。2)现场试验 干预我们将用6名参与者测试干预的初步可行性和可接受性， 对目标3进行必要的调整。3)进行干预的可行性试点。我们将确定 在特拉维斯县60名黑人妇女中的可行性，可接受性和初步疗效。参与者将 被随机分配到干预或基于网络的教育控制。我们假设 干预将是可行、可接受的，并显示出对完成家庭的有效性的趋势 测试，与护理的联系，以及与PrEP的联系。将在2，4， 和基线后6个月。干预措施的网络设计大大增加了 大规模实施。长期目标是在低收入黑人中增加艾滋病毒/性传播感染检测 通过可扩展和可持续的方法，减少艾滋病毒的传播和随后的差距。

PROJECT SUMMARY: In Travis County, Texas, deemed a HIV geographic hotspot due to high HIV rates, Black women are 18.4 times more likely to contract HIV compared to women of other races/ethnicities. Black women also have higher rates of sexually transmitted infections (STIs) than other women; many STIs have no symptoms, are undiagnosed, and are untreated. Having an STI triples one's risk for contracting HIV. In Travis County, over 20% of women learned one year after contracting HIV that they were HIV-positive, highlighting barriers to testing. Home HIV/STI testing has promise to increase rates of testing by circumventing barriers and thereby reduce medical costs through early detection and care. Home HIV/STI testing is also a prime opportunity to link Black women at high risk for HIV to pre-exposure prophylaxis (PrEP). Yet, home testing alone may not overcome all barriers. Pairing home testing with an intervention designed to increase motivation and overcome barriers has the most promise to increase HIV/STI testing rates. The proposed project draws on 3 components, the situated, information-motivation-behavioral (sIMB) model, mental contrasting, and implementation intentions to develop a new, web-based intervention. This intervention is comprised of 5 sessions: 1) using the HIV/STI home testing kit, 2) mailing in the kit, 3) checking results, 4) obtaining treatment, and 5) attending an appointment for PrEP. Each session is structured the same: information regarding the importance of each behavior (i.e., taking the home test, mailing in the test, checking results, linkage to care, and linkage to PrEP), motivation via mental contrasting (identifying positive outcomes and barriers to each session) and methods to overcome the identified barriers (implementation intentions), and behavioral skills to increase self-efficacy. The project will occur in 3 phases that coincide with the aims to develop and culturally tailor the intervention. 1) Conduct formative research to develop the intervention. Four focus groups (n=4-6), with 24 Black women from Travis County will explore the constructs of sIMB, mental contrasting, and implementation intentions to develop the intervention protocol to be field tested in Aim 2. 2) Field test the intervention. We will test the preliminary feasibility and acceptability of the intervention with 6 participants to make any necessary adjustments for Aim 3. 3) Conduct a feasibility pilot of the intervention. We will determine the feasibility, acceptability, and preliminary efficacy among 60 Black women in Travis County. Participants will be randomly assigned to the intervention or a web-based educational control. We hypothesize that the intervention will be feasible, acceptable, and demonstrate a trend toward efficacy for completion of home testing, linkage to care, and linkage to PrEP. Follow-up web-based assessments will be administered 2-, 4-, and 6-months after baseline. The web-based design of the intervention greatly increases the opportunity for implementation on a large scale. The long-term goal is to increase HIV/STI testing among low-income Black women via scalable and sustainable methods to decrease HIV transmission and subsequent disparities.