Microenterprise and Behavioral Economics Intervention for Sexual and Biomedical HIV Prevention in Vulnerable U.S. Young Adults

微型企业和行为经济学干预美国弱势年轻人的性和生物医学艾滋病毒预防

• 批准号: 10447764
• 负责人: Larissa Jennings Mayo-Wilson
• 金额: $ 71.25万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-08 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10447764
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; African American; African American population; Appointment; Behavior; Behavioral; Biometry; Businesses; Clinic; Communities; Control Groups; Data; Economics; Epidemiology; Financial Hardship; Gender; Generations; Grant; HIV; HIV Infections; HIV diagnosis; HIV risk; HIV-1; Heterogeneity; Homelessness; Human immunodeficiency virus test; Incidence; Income; Individual; International; Intervention; Mediating; Mediation; Mentors; Methods; Modeling; Motivation; Movement; Occupations; Outcome; Outcome Measure; Participant; Perception; Pharmaceutical Preparations; Population; Prevalence; Prevention; Prevention education; Prevention strategy; Preventive; Publishing; Qualitative Methods; Randomized; Resources; Respondent; Rewards; Risk; Risk Behaviors; Risk Reduction; Sampling; Science; Self Efficacy; Services; Sex Behavior; Sexual Health; Shapes; Statistical Methods; Text Messaging; Training; Translating; Treatment Efficacy; Unemployment; Unsafe Sex; Woman; Youth; acceptability and feasibility; age group; aged; behavioral adherence; behavioral economics; condoms; cost; design; efficacy evaluation; efficacy testing; empowerment; evidence base; experience; experimental group; financial literacy; health economics; health empowerment; high risk; high risk behavior; improved; insight; intervention effect; low income country; mHealth; marginalized population; medication compliance; men; participant interview; peer; peer support; post intervention; pre-exposure prophylaxis; primary outcome; racial disparity; randomized, clinical trials; recruit; sexual risk taking; skills; treatment as usual; uptake; urban setting; young adult

Project Summary / Abstract Economic vulnerability and racial disparities contribute to African-American young adults being disproportionately infected by HIV. African-Americans account for nearly half of all HIV diagnoses in the U.S., and young adults have the highest HIV rates of all U.S. age groups, comprising an increasing proportion of the urban poor. Economic instability, such as homelessness and unemployment, is associated with higher HIV prevalence. Experiencing economic instability can create imperatives to engage in survival strategies that increase HIV risk and diminish motivations to avoid HIV, resulting in sexual risk-taking and low uptake of preventive medications. Microenterprise interventions (i.e., very small businesses) have improved sexual behaviors and medication adherence in low-income countries by combining HIV prevention and business training, mentoring, and grants – primarily in women. Microenterprise reduces HIV risk through increased economic stability via jobs and employable income-generating skills. This, in turn, decreases financial distress associated with risk behaviors, while increasing resources to access HIV services and improving non-cognitive skills (i.e., persistence, grit) associated with healthy behaviors. However, microenterprise studies have largely been omitted in men and African-Americans with limited longitudinal assessment. Prior studies have also not leveraged mobile health or behavioral economics (BE) to shape how youth perceive prevention costs and rewards. Having obtained promising preliminary data from our completed K01 that demonstrated feasibility and acceptability of a microenterprise pilot, the proposed R01 builds on the K01 by establishing efficacy on two important HIV behavioral and biomedical primary outcomes: condomless sex and movement along the pre- exposure prophylaxis (PrEP) continuum (i.e., contemplation, clinic appointment, initiation), and on intermediate and mediating variables related to economic stability. We will implement a peer-driven microenterprise model, adapted for underserved U.S. communities. Our interdisciplinary team has expertise in prevention science, sexual health, microfinance, epidemiology, biostatistics, qualitative science, and behavioral economics. We will randomize participants to experimental group that will receive entrepreneurial, financial literacy, and HIV prevention education (i.e., condom use, PrEP), microgrants, mentors, text messages informed by BE, and job announcements or to control group that will receive usual care job announcements. We will use respondent- driven sampling to recruit high-risk, economically-vulnerable, HIV-uninfected seeds and their peers, aged 18- 24. To leverage peer support, we will randomize by cluster, equal to a seed and their recruits. The specific aims are to: (1) Evaluate the efficacy of the intervention on economic stability, condomless sex, and PrEP initiation up to 24-months post-intervention; (2) Assess heterogeneity of intervention effects; and (3) Examine mechanisms of change using statistical and qualitative methods. If found to be effective, the intervention has the potential to be a model of HIV risk reduction and economic empowerment in U.S. urban settings.

项目概要/摘要 经济脆弱性和种族差异导致非洲裔美国年轻人 不成比例地感染艾滋病毒。非裔美国人占美国艾滋病毒诊断总数的近一半， 在美国所有年龄组中，年轻人的艾滋病感染率最高，其中所占比例不断增加 城市贫民。经济不稳定，例如无家可归和失业，与艾滋病毒感染率升高有关 流行率。经历经济不稳定可能会迫使我们采取生存战略 增加艾滋病毒风险并削弱避免艾滋病毒的动机，导致性行为冒险和性行为低下 预防药物。微型企业干预措施（即非常小的企业）改善了性 通过将艾滋病毒预防和商业结合起来，改善低收入国家的行为和药物依从性 培训、指导和资助——主要针对女性。微型企业通过增加 通过就业和可就业的创收技能实现经济稳定。这反过来又减少了财务困境 与危险行为相关，同时增加获得艾滋病毒服务的资源并改善非认知能力 与健康行为相关的技能（即坚持、毅力）。然而，微型企业研究在很大程度上 在男性和非裔美国人中被忽略，纵向评估有限。之前的研究也没有 利用移动健康或行为经济学（BE）来塑造年轻人如何看待预防成本和 奖励。从我们已完成的 K01 中获得了有希望的初步数据，证明了可行性和 为了微型企业试点的可接受性，拟议的 R01 建立在 K01 的基础上，通过建立两个方面的功效 重要的艾滋病毒行为和生物医学主要结果：无安全套性行为和沿前的运动 暴露预防 (PrEP) 连续体（即考虑、诊所预约、启动）和中间 以及与经济稳定性相关的中介变量。我们将实施同行驱动的微型企业模式， 适合服务不足的美国社区。我们的跨学科团队拥有预防科学方面的专业知识， 性健康、小额信贷、流行病学、生物统计学、定性科学和行为经济学。我们将 将参与者随机分配到将接受创业、金融知识和艾滋病毒教育的实验组 预防教育（即安全套使用、PrEP）、小额赠款、导师、BE 通知的短信以及工作 公告或将收到常规护理工作公告的对照组。我们将使用受访者- 驱动抽样招募高风险、经济脆弱、未感染艾滋病毒的种子及其同龄人，年龄为 18- 24. 为了利用同行支持，我们将按集群随机分组，相当于种子及其新成员。具体的 目标是： (1) 评估干预措施对经济稳定、无套性行为和 PrEP 的有效性 干预后 24 个月内开始； （2）评估干预效果的异质性； (3) 检查 使用统计和定性方法的变化机制。如果发现有效，则干预措施已 有潜力成为美国城市环境中降低艾滋病毒风险和经济赋权的典范。