An RCT to train Black MSM as peer health educator for HIV testing and prevention

描述(由申请人提供)：在美国，HIV感染率最高的是男男性行为者(MSM)黑人男性。根据疾控中心2004-2005年全国艾滋病毒行为监测系统(NHBS)的数据，巴尔的摩在黑人MSM中艾滋病毒感染率最高，流行率为51%，发病率估计为每年8%。在2008年NHBS对黑人MSM的调查中，45%的人是阳性的。还有一个令人震惊的高比率的黑人男男性接触者的血清阳性，他们不知道自己的艾滋病毒阳性状态。在巴尔的摩NHBS的调查中，报告他们不知道自己血清状态的阳性黑人MSM的百分比在2004年至2005年为%，在2008年为77%。在减少黑人MSM中的艾滋病毒危险行为方面，缺乏证明有效或有效的干预措施。许多研究人员已经证明了针对黑人MSM特有的问题开发和定制艾滋病毒预防计划的重要性。基于我们最近针对黑人MSM的HIV预防干预试点的过程评估结果，并使用随机临床试验设计，我们计划将360名黑人MSM随机分为6节同伴健康教育者干预条件或同等注意力控制条件。我们设计了实验干预措施，为黑人MSM提供机会，发挥同伴健康教育者的积极社会作用。这一角色允许艾滋病毒预防性宣传和做法，而不侧重于污名化身份或行为，如艾滋病毒血清阳性或当前药物使用状况。拟议干预的主要目标是增加黑人MSM中艾滋病毒风险的降低，并增加VCT，降低风险，并在其风险网络成员中获得艾滋病毒医疗服务。同伴健康教育者将被鼓励为VCT招募最多5名性伴侣和其他黑人MSM。接受VCT的前2名网络成员将被邀请参加纵向研究。预计平均将有1.5名风险网络成员参加这项纵向研究。因此，样本将是360指数参与者和540名网络成员。我们将每隔6个月对指数参与者和网络参与者进行为期18个月的跟踪调查。主要结果将是艾滋病毒的性危险行为和为自愿咨询服务招募的网络成员数量。还将评估调解社会、环境和个人层面的因素。由于黑人男男性接触者中的非法药物使用是艾滋病毒的风险因素，而巴尔的摩的男男性接触者中吸毒率很高，我们建议按药物使用情况分层招募，指数参与者中有一半是目前使用可卡因、可卡因、甲基苯丙胺或非处方阿片类药物的人。 公共卫生相关性：迫切需要对黑人男男性接触者进行有效的行为干预，以预防、检测和医疗。拟议的干预措施旨在促进和传播艾滋病毒风险降低和VCT，并接触到黑人MSM及其风险伙伴的不同群体。这一干预措施旨在为卫生部门和社区组织实施低成本、可持续和可行的措施。它还被设计成在文化上适合城市黑人MSM及其网络成员。

DESCRIPTION (provided by applicant): In the US, the highest rates of HIV infection are among Black men who have sex with men (MSM). According to the CDC National HIV Behavioral Surveillance system (NHBS) in 2004-5, Baltimore had the highest HIV rates among Black MSM with prevalence of 51% and an incidence rates estimated to be 8% per year. In the 2008 NHBS survey of Black MSM, 45% were positive. There is also an alarmingly high rate of seropositive Black MSM who are not aware of their positive HIV status. The percent of positive Black MSM in the Baltimore NHBS survey who reported that they were unaware of their serostatus was 64% in 2004-5 and 77% in 2008. There is a dearth of Interventions that have demonstrated efficacy or effectiveness in reducing HIV risk behaviors among Black MSM. Many researchers have documented the importance of developing and tailoring HIV prevention programs to issues unique to Black MSM. Based on the process evaluation findings from our recent pilot HIV prevention intervention for Black MSM and using a randomized clinical trial design, we plan to randomize 360 Black MSM to either a 6-session Peer Health Educator intervention condition or an equal attention control condition. We have designed the experimental intervention to provide Black MSM an opportunity to perform a positive social role of peer health educator. This role allows for HIV preventive advocacy and practices without focusing on stigmatizing identities or behaviors, such as HIV seropositive or current drug use status. The primary goal of the proposed intervention is to increase HIV risk reduction among Black MSM and increase VCT, risk reduction, and access to HIV medical care among their risk network members. Peer Health Educators will be encouraged to recruit up to 5 sex partners and other Black MSM for VCT. The first 2 network members who receive VCT will be invited to the longitudinal study. It is anticipated that on average 1.5 risk network members will enroll in the longitudinal study. Thus, the sample will be 360 Index participants and 540 network members. We will follow-up both index and network participants' in six- month intervals for 18 months. The main outcomes will be HIV sexual risk behaviors and number of network members recruited for VCT. Mediating social environmental and individual level factors will also be assessed. As illicit drug use among Black MSM is a risk factor for HIV and there are high rates of drug use among MSM in Baltimore, we propose stratifying recruitment by drug use, with half of the index participants being current users of cocaine, crack, methamphetamines or non-prescription opiates. PUBLIC HEALTH RELEVANCE: There is an urgent need for effective behavioral interventions for HIV prevention, testing, and medical care for Black MSM. The proposed intervention is designed to promote and diffuse HIV risk reduction and VCT and reach a diverse group of Black MSM and their risk partners. This intervention has been designed to be low cost, sustainable, and feasible for health departments and community-based organizations to implement. It is also designed to be culturally appropriate for Black urban MSM and their network members.