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Implementation of a Sexual Health Intervention for YMSM in Two Vietnamese Cities

在越南两个城市实施 YMSM 性健康干预措施

基本信息

批准号：
8310667
负责人：
Michael C. Clatts
金额：
$ 67.92万
依托单位：
NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-06-01 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8310667
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Africa South of the Sahara Age Alcohol abuse Asia Awareness Behavioral Cambodia Caring Cessation of life China Cities Clinic Collaborations Communities Community Health Services Community Outreach Complex Country Cross-Sectional Studies Data Dependency Development Discipline of Nursing Discrimination Early Diagnosis Economics Education Effectiveness Enrollment Epidemic Epidemiologic Studies Epidemiology Ethnography Evaluation Exposure to Face Female Fostering Funding Future Gays Goals HBV Vaccination HIV HIV/STD Harm Reduction Health Promotion Health Services Healthcare Hepatitis B Virus Hepatitis C virus High Prevalence Human Papillomavirus Human immunodeficiency virus test Incidence Income India Individual Indonesia Infection International Intervention Knowledge Life Mental Depression Mental Health Methods Modeling Myanmar National Institute of Drug Abuse Nurses Outcome Outcome and Process Assessment Participant Pattern Pharmaceutical Preparations Policies Population Population Sizes Prevention Prevention program Process Protocols documentation Recording of previous events Research Research Design Research Infrastructure Risk Risk Reduction Route Screening procedure Self Perception Services Sexual Health Singapore South Korea Southeastern Asia Stigmata Symptoms Technology Testing Thailand Time Unsafe Sex Vaccination Vietnam Work Youth base disorder control experience high risk holistic approach implementation science improved interest male male sex worker men who have sex with men metropolitan neglect outreach peer prevention service programs response risk perception service intervention sex skills social social stigma surveillance data systematic review therapy development transmission process uptake

项目摘要

DESCRIPTION (provided by applicant): Both surveillance and behavioral epidemiological studies show that young male sex workers (YMSWs) in Vietnam have high rates of unprotected sex with multiple, concurrent partners - including both male and female partners - contributing to high rates of STIs and HIV and amplifying already high HIV incidence. Exposure to existing prevention programming is low, with major gaps in HIV knowledge and sexual risk reduction skills. Existing community outreach activities have primarily reached gay-identified YMSM. Moreover, owing to profound risk for stigma and discrimination in health care settings, few YMSW are engaged and retained in protective health services (including STI/HIV screening, HBV/HPV vaccination, and early linkages to HIV care). Our collaborative US/Vietnam research team has been conducting NIDA-funded HIV research among high risk youth populations, including YMSWs, for the past eight years. Building on the substantial research capacity and health services infrastructure that has been achieved in our prior work, we propose to address these gaps in community outreach and health services access by implementing a composite intervention package targeted to YMSWs in the two strategically selected cities in Vietnam (Hanoi and Ho Chi Minh City). Using Sexual Health Promotion as a conceptual framework, we will combine already proven intervention technologies - community outreach nursing and sexual health promotion interventions - to enhance outreach coverage and to foster engagement and retention in health services. Significant levels of outreach coverage will be achieved (with an estimated 12,000 outreach contacts) and substantial numbers of health services will be delivered (2,400 health services participants). Using a mixed-methods approach that includes anthropological ethnography, social and behavioral epidemiology, and health services assessments, process and outcomes evaluation of both the community outreach and health services intervention will be undertaken. Repeated cross-sectional surveys, administered both prior to and following implementation of the community outreach and health services intervention, will document community-level increases in exposure to outreach, increased knowledge and awareness of behavioral HIV risk, increased sexual risk reduction skills and participation in the clinic-based sexual health promotion intervention, thus demonstrating effective engagement and retention in health services. Of particular interest to implementation science, both qualitative and quantitative analysis will assess between-city differences in intervention uptake and effectiveness, data that will inform our understanding of the impact, adaptability, and generalizability of the intervention and guide future dissemination. PUBLIC HEALTH RELEVANCE: Young male sex workers in Vietnam show high prevalence rates of HIV and other STIs, reflecting their involvement in multiple concurrent sex exchanges with both male and female partners, yet they have limited exposure to, or engagement in, health services, including community outreach, HIV/STI testing and treatment, and vaccination for HBV and HPV. Building on the substantial research capacity and health services infrastructure developed in our prior research collaboration in Vietnam, we propose to address these gaps in community outreach and health services access by using Sexual Health Promotion as a conceptual framework, and a research design based on principles of implementation science to deliver an intervention that combines already proven intervention technologies - community outreach nursing and sexual health promotion interventions - to enhance outreach coverage and to foster engagement and retention in health services among YMSWs in the two strategically selected cities in Vietnam (Hanoi and Ho Chi Minh City). It is anticipated that the intervention will significantly contribute to intervention capacity-building in Vietnam and may als contribute to intervention development in neighboring countries in Southeast Asia that face similar challenges.

描述（由申请人提供）：监测和行为流行病学研究均表明，越南的年轻男性性工作者 (YMSW) 与多个同时性伴侣（包括男性和女性伴侣）发生无保护性行为的比例很高，这导致了性传播感染和艾滋病毒的高发病率，并加剧了本已很高的艾滋病毒发病率。现有预防规划的参与度较低，艾滋病毒知识和降低性风险技能方面存在重大差距。现有的社区外展活动主要针对同性恋 YMSM。此外，由于卫生保健机构存在严重的耻辱和歧视风险，很少有 YMSW 参与并保留在保护性卫生服务中（包括性传播感染/艾滋病毒筛查、乙型肝炎病毒/HPV 疫苗接种以及与艾滋病毒护理的早期联系）。过去八年，我们的美国/越南合作研究团队一直在 NIDA 资助的高危青年人群（包括 YMSW）中开展艾滋病毒研究。基于我们之前工作中已取得的大量研究能力和卫生服务基础设施，我们建议通过实施针对越南两个战略选择城市（河内和胡志明市）的 YMSW 的综合干预方案来解决社区外展和卫生服务获取方面的差距。以性健康促进为概念框架，我们将结合已经行之有效的干预技术——社区外展护理和性健康促进干预措施——以扩大外展覆盖范围，并促进卫生服务的参与和保留。将实现较高水平的外展覆盖（估计有 12,000 名外展联系人），并将提供大量卫生服务（2,400 名卫生服务参与者）。将采用包括人类学民族志、社会和行为流行病学以及卫生服务评估在内的混合方法，对社区外展和卫生服务干预的过程和结果进行评估。在实施社区外展和卫生服务干预之前和之后进行的重复横断面调查将记录社区层面外展接触率的增加、对行为艾滋病毒风险的了解和认识的提高、降低性风险的技能以及对基于临床的性健康促进干预的参与的提高，从而证明对卫生服务的有效参与和保留。对实施科学特别感兴趣的是，定性和定量分析将评估城市间在干预措施的采用和有效性方面的差异，这些数据将帮助我们了解干预措施的影响、适应性和普遍性，并指导未来的传播。公共卫生相关性：越南的年轻男性性工作者艾滋病毒和其他性传播感染的患病率很高，这反映出他们与男性和女性伴侣同时进行多次性行为，但他们接触或参与的卫生服务有限，包括社区外展、艾滋病毒/性传播感染检测和治疗以及乙型肝炎病毒和HPV疫苗接种。基于我们之前在越南的研究合作中开发的大量研究能力和卫生服务基础设施，我们建议通过使用性健康促进作为概念框架和基于实施科学原则的研究设计来解决社区外展和卫生服务获取方面的这些差距，并根据实施科学原则进行研究设计，以提供结合了已经行之有效的干预技术（社区外展护理和性健康促进干预措施）的干预措施，以提高外展覆盖率并促进卫生服务的参与和保留越南两个战略选定城市（河内和胡志明市）的 YMSW 中。预计此次干预将极大促进越南的干预能力建设，也可能有助于面临类似挑战的东南亚邻国的干预发展。