Addressing the continuum of care among high-risk Thai men

项目摘要 泰国的艾滋病毒流行病在男男性行为青年中不断升级。 特别是，在泰国东北部，YMSM中的艾滋病毒流行率估计为10-15%。显然 高风险性行为正在发生，艾滋病毒检测的接受率仍然很低，尽管免费检测 公共诊所提供服务。尽管政府提供免费抗逆转录病毒治疗， 政府，不到25%的艾滋病毒阳性YMSM（艾滋病毒+YMSM）被留在照顾，这表明很少 已经实现了病毒抑制。艾滋病毒感染者获得艾滋病毒检测和治疗服务的机会欠佳， 青年男同性恋者在急需的预防工作中提出了巨大的挑战，以改善与护理的联系， 实现对个人和社区病毒的抑制，以防止艾滋病毒的进一步传播。社区 针对个人、社会/社区障碍的动员和赋权方法， 需要提高卫生系统的水平，以改善获得预防和治疗服务的机会， 减少风险、艾滋病毒检测以及护理连续体的联系和参与。基于一种文化 适应以证据为基础的赋权干预，我们开发和试点HUG-M，一个多， 水平，以理论为基础的干预，分散社会支持和授权YMSM社区， 建立支持减少风险和一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，可行的实施，并有可能增加艾滋病毒检测和 降低性风险行为。拟议的研究将测试社区动员，多层次 在泰国东北部两个匹配良好的城市进行干预。该项目的目标是：（1）完成和 手册HUG-M+，一个社区动员，多成分，多层次，组合干预， 重点放在整个预防和护理的连续性，（2）实施HUG-M+两年， 与泰国公共卫生部（MOPH）提供艾滋病毒检测和 治疗，（3）评估HUG-M+在降低性风险行为方面的试验性疗效; 至少每两年进行一次艾滋病毒检测;增加对生活在艾滋病毒/艾滋病中的男性的迅速、持续的护理 （a）泰国东北部两个城市的YMSM纵向队列;过抽样 HIV+YMSM，将提供CC的数据，包括性风险行为;肛门细菌性传播感染; HIV 检测频率;和艾滋病毒+YMSM之间的护理参与;和（B）纵向公共卫生数据， 公共卫生部已经收集了这些数据，其中包括艾滋病毒患者的CD 4和病毒载量数据。如果这个飞行员 为了有效，可能会建议对它进行更大规模、多地点的后续研究。

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.