Addressing the continuum of care among high-risk Thai men

解决泰国高危男性的持续护理问题

• 批准号: 10438574
• 负责人: THOMAS E GUADAMUZ
• 金额: $ 53.12万
• 依托单位: MAHIDOL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10438574
• 关键词: AIDS prevention; Address; Age; Anus; Asia; Capital; Caring; Cities; Clinic; Clinical; Collaborations; Communities; Community Health Systems; Continuity of Patient Care; Country; Data; Detection; Diagnosis; Diffuse; Epidemic; Exposure to; Family; Frequencies; Friends; Fright; Funding; Government; HIV; HIV Seropositivity; HIV/STD; Health Personnel; Health care facility; Health system; Human Rights; Human immunodeficiency virus test; Improve Access; Incidence; Individual; Integration Host Factors; Intervention; Learning; Lesbian Gay Bisexual Transgender; Link; Longitudinal cohort; Manuals; Methods; Patients; Persons; Pilot Projects; Prevalence; Prevention; Prevention strategy; Public Health; Randomized; Reporting; Research; Risk Behaviors; Risk Reduction; Safe Sex; Sexual Health; Sexual Partners; Sexuality; Social Change; Social isolation; Social support; Societies; Southeastern Asia; Stigmatization; Stress; Testing; Thailand; Thinking; Time; Viral; Viral Load result; antiretroviral therapy; base; cohort; community involvement; efficacy evaluation; efficacy testing; empowered; empowerment; evidence base; experience; follow-up; health data; high risk; high risk sexual behavior; improved; innovation; literacy; men; men who have sex with men; prevent; prevention service; randomized controlled study; recruit; scale up; sex; sexual minority stress; sexual risk behavior; skills; social; social norm; social stigma; standard of care; testing services; testing uptake; theories; transmission process; treatment services; uptake; young man; young men who have sex with men

Project Summary The HIV epidemic in Thailand is escalating among young men who have sex with men (YMSM). Particularly, HIV prevalence among YMSM is estimated to be 10-15% in Northeastern Thailand. Obviously high risk sexual behavior is occurring, and the uptake of HIV testing remains low even though free testing services are offered by public clinics. Despite provision of free antiretroviral treatment (ART) by the government, less than 25% of HIV-positive YMSM (HIV+YMSM) are retained in care, suggesting very few have achieved viral suppression. The suboptimal access to HIV testing and treatment services among YMSM pose tremendous challenge in much needed prevention efforts to improve linkage to care and achieve individual and community viral suppression to prevent onward HIV transmission. Community mobilization and an empowerment approach that targets barriers at individual, social/community, and health systems levels are needed to improve access to prevention and treatment services, including sexual risk reduction, HIV testing, and linkage and engagement in the care continuum (CC). Based on a cultural adaptation of the evidence-based Mpowerment intervention, we developed and piloted HUG-M, a multi- level, theory-based intervention that diffuses social support and empowers the YMSM community in order to establish social norms supportive of risk reduction and biannual HIV testing. HUG-M was acceptable to YMSM in a prior pilot study, feasible to implement, and has the potential to increase HIV testing and decrease sexual risk behavior. The proposed study will test a community mobilization, multi-level intervention in two well-matched cities in Northeastern Thailand. The project’s aims are: (1) to finalize and manualize HUG-M+, a community mobilization, multicomponent, multi-level, combination intervention that focuses on the entire Continuum of Prevention and Care, (2) to implement HUG-M+ for 2 years in collaboration with the Thailand Ministry of Public Health (MOPH) clinics that provide HIV testing and treatment, and (3) to evaluate the pilot efficacy of HUG-M+ in decreasing sexual risk behavior; increasing HIV testing to at least biannually; and increasing prompt, sustained engagement in care among men living with HIV by (a) longitudinal cohorts of YMSM in two cities in Northeastern Thailand; oversampling HIV+YMSM, which will provide data on the CC including sexual risk behavior; anal bacterial STIs; HIV testing frequency; and engagement in care among HIV+YMSM; and (b) longitudinal public health data, already collected by the MOPH, which include CD4 and viral load data for HIV patients. If this pilot is shown to be effective, a follow-up larger, multisite study of it may be proposed.

项目概要 泰国的艾滋病毒流行在男男性行为者 (YMSM) 中的年轻男性中不断升级。 特别是，在泰国东北部，YMSM 人群中的艾滋病毒感染率估计为 10-15%。明显地 高风险性行为正在发生，尽管免费检测，艾滋病毒检测的采用率仍然很低 服务由公立诊所提供。尽管政府提供免费的抗逆转录病毒治疗（ART） 政府表示，只有不到 25% 的 HIV 阳性 YMSM (HIV+YMSM) 被保留在护理中，这表明很少有人 已实现病毒抑制。获得艾滋病毒检测和治疗服务的机会不佳 YMSM 在急需的预防工作中提出了巨大的挑战，以改善与护理和治疗的联系 实现个人和社区病毒抑制，以防止艾滋病毒继续传播。社区 针对个人、社会/社区和社区的障碍的动员和赋权方法 卫生系统水平需要改善获得预防和治疗服务的机会，包括性服务 降低风险、艾滋病毒检测以及护理连续体 (CC) 中的联系和参与。立足于文化 为了适应基于证据的赋权干预措施，我们开发并试行了 HUG-M，这是一种多 水平、基于理论的干预，分散社会支持并赋予 YMSM 社区权力，以便 建立支持降低风险和每年两次艾滋病毒检测的社会规范。 HUG-M 可以接受 YMSM 在先前的试点研究中可行，并且有可能增加 HIV 检测和 减少性危险行为。拟议的研究将测试社区动员、多层次的 对泰国东北部两个匹配的城市进行干预。该项目的目标是：（1）最终确定并 手动化 HUG-M+，这是一项社区动员、多组成部分、多层次、组合干预措施， 重点关注整个预防和护理的连续性，(2) 在 2019 年实施 HUG-M+ 2 年 与泰国公共卫生部 (MOPH) 诊所合作，提供艾滋病毒检测和 治疗，以及 (3) 评估 HUG-M+ 在减少危险性行为方面的试点效果；增加 至少每半年进行一次艾滋病毒检测；以及增加生活在男性中的迅速、持续的护理参与 (a) 泰国东北部两个城市的 YMSM 纵向队列感染艾滋病毒；过采样 HIV+YMSM，将提供有关 CC 的数据，包括性危险行为；肛门细菌性性传播感染；艾滋病病毒 测试频率； HIV+YMSM 患者的护理参与度； (b) 纵向公共卫生数据， MOPH 已经收集了这些数据，其中包括 HIV 患者的 CD4 和病毒载量数据。如果显示此飞行员 为了取得成效，可能会建议对其进行后续更大规模的多地点研究。