Promoting linkage to PrEP after HIV self-testing through a peer-led intervention for MSM

项目摘要 结束艾滋病毒流行将需要新的战略来扩大男子的艾滋病毒预防连续体。 与感染艾滋病毒的男性(MSM)发生性行为。新冠肺炎大流行已经 强调需要采取诸如艾滋病毒自我检测等远程护理方法，以维持获得艾滋病毒的机会 服务。然而，自我测试的好处是有限的，如果它们不刺激行为改变或与 然而，只有十分之一的自测男男性行为者在事后获得了预防保健，而大多数患有 PrEP的适应症从未使用过它。支持HIVST连锁的干预措施，这是 艾滋病毒“地位中立”的连续体，是需要的。为了最大限度地发挥HIVST的影响，与护理的联系是至关重要的 需要解决的实践差距，这一差距可能可以通过同行干预来弥合 支持联动和PrEP摄取。为了扩大男男性接触者中艾滋病毒的预防连续体，这项研究将 利用HIVST并评估同行主导的干预，通过以下方式支持参与护理和PrEP 自检后的同级联动。这一职业发展奖的总体目标是为塞德里克·比恩博士提供- Gund拥有必要的研究技能，可以成为发展中的独立临床医生兼研究员， 评估和实施预防艾滋病毒感染的行为干预措施。为了实现这一目标，我们 我组建了一个指导团队，并提出了一项严格的培训计划，以发展他在混合语言中的技能 行为干预方法，2)干预设计和实施地图，3)先进 临床试验设计，包括实施科学设计。这些培训目标是对 研究计划开发和试点一种行为干预措施，通过以下方式增加MSM与PrEP的联系 将HIVST分配和同行主导的链接整合到PrEP。具体目标是：1)找出障碍和 MSM中HIV自我检测后PrEP链接的促进者，2)开发同伴主导的链接干预 HIVST，以及3)测试干预PrEP连锁和初步效果的可接受性、可行性和初步效果 通过进行先导性随机对照试验在男男性接触者中的吸收。该项目将利用正在进行的 与费城公共卫生部合作，扩大HIVST和PrEP的普及。这个 拟议的研究涉及艾滋病毒预防连续体的第一步，并将支持Bien-Gund博士的 目标是成为一名独立的调查员，在结束艾滋病毒的行为干预方面具有专业知识 流行病。这项研究将为R01应用程序提供初步数据，以测试混合动力系统中的干预 第一类有效性--执行试验，目的是通过关闭联系来优化HIVST的影响 测试后的差距。

Project Summary Ending the HIV epidemic will require novel strategies to expand the HIV prevention continuum among men who have sex with men (MSM), who are disproportionately affected by HIV. The COVID-19 pandemic has underscored the need for remote care approaches such as HIV self-testing (HIVST) to sustain access to HIV services. However, the benefits of self-testing are limited if they do not spur behavioral change or linkage to care, yet only 1 in 10 MSM who self-test obtain preventive care afterwards, and the majority of MSM with indications for PrEP have never used it. Interventions to support linkage from HIVST, the first key step in the HIV “status neutral” continuum, are needed. To maximize the impact of HIVST, linkage to care is a critical practice gap that needs to be addressed, a gap that can potentially be bridged by a peer intervention to support linkage and PrEP uptake. To expand the HIV prevention continuum among MSM, this research will leverage HIVST and evaluate a peer-led intervention to support engagement in care and PrEP uptake through peer linkage after self-testing. The overall goal of this career development award is to provide Dr. Cedric Bien- Gund with the necessary research skills to become an independent clinician-investigator in the development, evaluation, and implementation of behavioral interventions to prevent HIV infections. To achieve this goal, we have assembled a mentoring team and proposed a rigorous training plan to develop his skills in 1) mixed methods for behavioral interventions, 2) intervention design and mapping for implementation, and 3) advanced clinical trial design, including implementation science designs. These training objectives complement a research plan to develop and pilot a behavioral intervention to increase linkage to PrEP among MSM through integration of HIVST distribution and peer-led linkage to PrEP. The specific aims are: 1) identify barriers and facilitators to PrEP linkage after HIV self-testing among MSM, 2) develop a peer-led linkage intervention for HIVST, and 3) test the acceptability, feasibility, and preliminary efficacy of the intervention on PrEP linkage and uptake among MSM by conducting a pilot randomized controlled trial. This project will leverage an ongoing collaboration with the Philadelphia Department of Public Health to expand HIVST and PrEP uptake. The proposed research addresses the first steps in the HIV prevention continuum and will support Dr. Bien-Gund's goal of becoming an independent investigator with expertise in behavioral interventions to end the HIV epidemic. This research will provide preliminary data for an R01 application to test the intervention in a hybrid type I effectiveness-implementation trial, with the goal of optimizing the impact of HIVST by closing the linkage gap after testing.