Developing a U.S. National Cohort to Improve Virologic Suppression among Stimulant-using Men Living with HIV.

项目总结/摘要 在性少数男性/男男性行为者中，包括那些 艾滋病毒感染者，可能会通过干扰艾滋病毒护理而损害美国结束艾滋病毒流行病的目标 参与，坚持和病毒学抑制性少数男性艾滋病毒感染者。突出 多层次的障碍干扰了感染艾滋病毒的性少数男性的艾滋病毒病毒学抑制， 特别是那些使用兴奋剂的人。 我们将以数字方式招募至少1，000名感染艾滋病毒的性少数男性，其中至少40%将识别 作为黑人/非洲裔美国人，至少70%的人将积极使用兴奋剂，以确定多层次的决定因素 性少数男性艾滋病毒感染者的艾滋病毒护理参与、坚持和病毒学抑制， 使用和不使用兴奋剂。在社会生态模型的指导下，我们将研究网络因素（艾滋病毒 状态，兴奋剂使用），地理空间决定因素（背景兴奋剂使用流行率，EHE地区），以及其他 影响病毒学抑制的结构性因素（交叉污名、结构性种族主义）（目标1）。后 招募里程碑得到满足，我们将进行一项嵌套随机临床试验，以测试多组分 干预以改善性行为者中病毒学抑制、依从性、积极影响和兴奋剂使用 使用兴奋剂的少数艾滋病毒感染者（n = 300）。这项干预行动被称为"重新启动"，将联合收割机 通过智能手机应用程序和使用尿液点提供基于证据的积极影响干预， 护理测试，以执行依从性自我监测，并提供激励信息，以改善或维持 通过reSTART应用程序提供的依从性（目标2）。在建议的目标3中，我们会评估 重新启动病毒学抑制和最佳抗逆转录病毒治疗依从性的人均增量成本 通过头发中替诺福韦的水平来测量。 在这项高影响力的研究结束时，我们将确定治疗连续性的多层次决定因素 在感染艾滋病毒的数字招募的性少数男性中，包括那些使用兴奋剂的人; 使用新的护理点依从性自我的多组件reSTART mHealth干预的影响， 监测艾滋病毒的病毒学抑制，坚持和成本中的一个关键的服务不足的人群。

PROJECT SUMMARY/ ABSTRACT A resurgent stimulant epidemic among sexual minority men/men who have sex with men, including those living with HIV, could compromise the U.S. Ending the HIV Epidemic goals by interfering with HIV care engagement, adherence, and virologic suppression among sexual minority men living with HIV. Prominent multi-level barriers interfere with HIV virologic suppression among sexual minority men living with HIV, particularly among those who use stimulants. We will digitally recruit at least 1,000 sexual minority men living with HIV, of whom at least 40% will identify as Black/African-American and at least 70% will have active stimulant use to identify multi-level determinants of HIV care engagement, adherence, and virologic suppression among sexual minority men living with HIV, with and without stimulant use. Guided by the social ecological model, we will investigate network factors (HIV status, stimulant use), geospatial determinants (background stimulant use prevalence, EHE region), and other structural factors (intersectional stigma, structural racism) that affect virologic suppression (Aim 1). After recruitment milestones are met, we will perform a nested randomized clinical trial to test a multi-component intervention to improve virologic suppression, adherence, positive affect, and stimulant use among sexual minority men living with HIV who use stimulants (n=300). The intervention, known as reSTART, will combine an evidence-based positive affect intervention delivered through a smartphone app and use of urine point-of- care testing to perform adherence self-monitoring, with motivational messages to improve or maintain adherence delivered via the reSTART app (Aim 2). In Aim 3 of the proposal, we will assess the impact of reSTART on incremental cost per person on virologic suppression and optimal antiretroviral therapy adherence measured via hair tenofovir levels. By this high-impact study’s end, we will have identified multi-level determinants of the treatment continuum among digitally-recruited sexual minority men living with HIV, including among those who use stimulants; and the impact of a multi-component reSTART mHealth intervention using novel point-of-care adherence self- monitoring on HIV virologic suppression, adherence, and cost among a key underserved population.