Enhancing HIV Prevention and Treatment Referral and Engagement among Latino MSM: A Pilot Hybrid Effectiveness-Implementation Trial of the JUNTOS Referral Network

加强拉丁裔 MSM 的艾滋病毒预防和治疗转诊和参与：JUNTOS 转诊网络的混合有效性实施试验

• 批准号: 10759875
• 负责人: Audrey Harkness
• 金额: $ 69.68万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10759875
• 关键词: AIDS prevention; Address; Affect; Caring; Client; Clinical; Communities; Control Groups; County; Data; Disparity; Effectiveness; Epidemic; Florida; Funding; Goals; HIV; Health; Healthcare Systems; Human immunodeficiency virus test; Immigration; Incidence; Intervention; Knowledge; Latino; Maintenance; Measures; Mental Health; Methods; Outcome; Participant; Pilot Projects; Population; Preparation; Prevention; Prevention approach; Procedures; Proctor framework; Professional counselor; Prophylactic treatment; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Resources; Self Efficacy; Services; Testing; Training; Transportation; Universities; Viral; Work; antiretroviral therapy; arm; community engagement; consumer demand; cultural competence; effectiveness outcome; effectiveness/implementation hybrid; effectiveness/implementation trial; evidence base; experience; implementation determinants; implementation evaluation; implementation framework; implementation outcomes; implementation strategy; improved; innovation; men who have sex with men; pilot test; pilot trial; prevent; prevention effectiveness; prevention service; prototype; recruit; scale up; tool; treatment as prevention; treatment services

Abstract. Ending the HIV epidemic will require dramatically expanding the reach of biomedical prevention tools to populations needing them most. Despite the availability and effectiveness of prevention approaches including pre- and post- exposure prophylaxis (PrEP, PEP) and treatment as prevention, men who have sex with men continue to acquire HIV at the highest rates in the US. Latino MSM (LMSM), comprising 31% of these cases, experience marked disparities. Therefore, the need is urgent for culturally grounded and effective implementation strategies to enhance the reach of evidence-based HIV prevention tools across the prevention cascade for LMSM. Accordingly, our team used community engaged methods to develop a prototype for one such implementation strategy – the JUNTOS (Joining Under-connected Networks To Optimize Salud) Referral Network – to improve the reach of PrEP, PEP, and rapid antiretroviral treatment (ART) to LMSM. The implementation strategy seeks to improve reach by (a) improving implementers' ability to navigate LMSM to PrEP, PEP, and rapid ART; and (b) increasing demand from LMSM for services. Our planning work to develop JUNTOS was funded by a federal Ending the HIV Epidemic (EHE) supplement and included academic (University of Miami, Northwestern University), implementation (Florida Department of Health, Care Resource), and community partners (LMSM Advisory Board). The next logical step is to develop JUNTOS fully and conduct our proposed type III hybrid effectiveness-implementation trial, with the following aims. Aim 1: Evaluate, at the HIV test counselor level, the implementation outcomes associated with the JUNTOS Referral Network implementation strategy. We will recruit and randomize Miami-Dade County (MDC)-based HIV test counselors (N=45) 2:1 to either receive JUNTOS or the non-tailored referral list that HIV test counselors currently use in MDC (control). JUNTOS recipients will receive training to use JUNTOS for referring their LMSM testing clients. We will then evaluate implementation and maintenance, and explore hypothesized mechanisms (e.g., knowledge, network), and also assess acceptability, appropriateness, and feasibility. Aim 2: Evaluate implementation and effectiveness outcomes, at the LMSM level, associated with the JUNTOS Referral Network. We will track the extent to which LMSM testing clients served by Aim 1 test counselors are reached by evidence-based HIV prevention and treatment services. Up to 5 LMSM testing clients per HIV test counselor in the trial will complete brief assessments to evaluate the reach of PrEP, PEP, and rapid ART before and after their testing session. We will explore differences in PrEP, PEP, and rapid ART reach between LMSM seen by HIV test counselors in the two arms of the pilot trial, and will also explore effectiveness outcomes. Completing this R34 will provide data on JUNTOS' acceptability, appropriateness, and feasibility, and preliminary data on the degree to which JUNTOS is an evidence-based implementation strategy, informing refinements for a fully powered hybrid effectiveness-implementation trial aligned with EHE priorities.

抽象的。结束艾滋病毒的流行需要大幅度扩大生物医学预防的范围 向最需要的人群提供工具。尽管预防方法的可用性和有效性 包括暴露前和暴露后预防（PrEP，PEP）和作为预防的治疗， 在美国，男性感染艾滋病毒的比率仍然最高。拉丁裔男男性接触者（LMSM），占31%， 案例中，经验差距明显。因此，迫切需要有文化基础和有效的 实施战略，以扩大循证艾滋病毒预防工具在预防工作中的覆盖面 LMSM的级联。因此，我们的团队使用社区参与的方法来开发一个原型 这种实施战略-JUNTOS（加入连接不足的网络以优化健康）转介 网络-提高预防性接触、预防性接触和快速抗逆转录病毒治疗对LMSM的覆盖率。的 实施战略旨在通过以下方式提高覆盖面：（a）提高实施者驾驭LMSM的能力， PrEP、PEP和快速抗逆转录病毒疗法;以及（B）LMSM对服务的需求不断增加。我们的规划工作， JUNTOS由联邦终止艾滋病毒流行（EHE）补充基金资助， （迈阿密大学，西北大学），实施（佛罗里达卫生部，护理资源）， 和社区合作伙伴（LMSM咨询委员会）。下一个合乎逻辑的步骤是充分开发JUNTOS， 进行我们提出的第三类混合有效性实施试验，目的如下。目标1： 在艾滋病毒检测顾问一级评估与JUNTOS转介相关的实施成果 网络实施战略。我们将招募并随机进行迈阿密-戴德县（MDC）的艾滋病毒检测 咨询师（N=45）2：1接受JUNTOS或非定制的转诊名单， 目前在MDC中使用（对照）。JUNTOS的接受者将接受培训，使用JUNTOS来介绍他们的 LMSM测试客户端。然后，我们将评估实施和维护，并探讨假设 机构（例如，知识、网络），并评估可接受性、适当性和可行性。目标二： 在LMSM一级评价与JUNTOS有关的执行情况和有效性成果 转介网络。我们将跟踪由Aim 1测试顾问服务的LMSM测试客户的程度， 获得循证艾滋病毒预防和治疗服务。每次HIV检测最多5名LMSM检测客户 试验中的顾问将完成简短的评估，以评估PrEP，PEP和快速ART的覆盖范围 在测试前后我们将探讨PrEP，PEP和快速ART达到之间的差异 艾滋病检测咨询师在两个试验组中看到了LMSM，并且还将探索其有效性 结果。完成本R34将提供JUNTOS可接受性、适当性和可行性的数据， 以及关于联合国陆地观测系统方案在多大程度上是一项循证执行战略的初步数据， 完善了与EHE优先事项一致的全动力混合动力有效性实施试验。