Development and Evaluation of a Multilevel, Socio-Culturally Contextualized Digital Health Decision Intervention to Reduce Medical Mistrust and Improve Status-Neutral HIV Service Use among HLMSM

开发和评估多层次、社会文化背景的数字健康决策干预措施，以减少 HLMSM 中的医疗不信任并改善状态中立的艾滋病毒服务使用

• 批准号: 10790605
• 负责人: VINCENT M. GUILAMO-RAMOS
• 金额: $ 46.03万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10790605
• 关键词: Development; Evaluation; Multilevel; Socio; Culturally

Project Summary/Abstract: HIV disproportionately affects Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM), threatening progress toward the Ending the HIV Endemic (EHE) initiative’s 2030 goals. Medical mistrust (MM) among HLMSM, which is associated with reduced engagement with HIV prevention and treatment services, has been identified as an important root cause and driver in sustaining and exacerbating HIV inequities among HLMSM. Thus, research to understand and address factors that shape MM and HIV service trustworthiness (MMT) in key geographies of elevated HIV incidence among HLMSM represents a public health priority to enable progress toward meeting national EHE goals. Throughout the proposed project, the HLMSM-led investigative team will partner with a steering committee consisting of HLMSM, community leaders with strong community ties to the Hispanic/Latino (H/L) community and HLMSM, healthcare providers who serve HLMSM, academic partners with subject expertise relevant to the proposed study activities and methods, media and communication partners with strong connections to the HLMSM community, and other key stakeholders. The project consists of two integrated study phases focusing on five geographic areas — Los Angeles County, CA; Bronx County, NY; Bexar County, TX; Miami-Dade County, FL; and San Juan Municipio, PR — that align with EHE priority jurisdictions and account for a significant burden of HIV incidence among HLMSM across the US. During Phase I, we will conduct formative research to inform the development of a multilevel digital health intervention and to identify existing local interventions that address MM among HLMSM, including (1) in-depth interviews with N=60 diverse HLMSM exploring the root causes and pathways shaping MMT and HIV service use as well as concept validity, verification, and reliability to inform quantitative measurement protocols; (2) focus groups (2-3 per geography) with N=6-8 HLMSM exploring acceptability and feasibility of and preferences for a digital MMT intervention as well as perspectives on participant recruitment and retention methods; (3) interviews with N=50 key informants (HIV service providers, H/L community leaders, local elected officials) about their experiences with MM among HLMSM, local and organizational laws/policies that contribute to MMT, and recommendations for decreasing MM among HLMSM; and (4) a cross-sectional online survey with N=1,625 HLMSM exploring correlates of MMT and HIV service use. In Phase II, we will conduct a three-arm (1:1:1) parallel explanatory randomized control trial to evaluate the efficacy of our digital health intervention in addressing MMT and improving use of status-neutral HIV services among HLMSM. N=336 HLMSM will be recruited from each of the five project geographies (N=1,680 total) and randomly assigned to receive either the multilevel digital intervention alone (interactive web platform and downloadable intervention workbook and toolkit), or multilevel digital intervention plus peer navigation (telehealth component with participants and an HLMSM peer navigator), or the standard of care (referral to existing local HIV prevention/treatment services).

项目摘要/摘要： 艾滋病毒不成比例地影响西班牙裔/拉丁裔同性恋，双性恋和其他与男人发生性关系的男人（HLMSM）， 威胁要结束艾滋病毒流行（EHE）倡议的2030年目标的进展。医疗不信任（MM） 在与艾滋病毒预防和治疗服务的参与下有关的HLMSM中， 已被确定为维持和加剧HIV不平等的重要根本原因和驱动因素 HLMSM。这是为了理解和解决塑造MM和HIV服务可信度的因素的研究 （MMT）在HLMMM中，HIV升高事件的关键地理位置中，是公共卫生的优先事项 实现国家目标的进步。通过拟议的项目，由HLMSM领导 调查小组将与由HLMSM组成的指导委员会合作 社区与西班牙裔/拉丁裔（H/L）社区和HLMMSM联系，为HLMSM服务的医疗保健提供者， 具有主题专业知识的学术合作伙伴与拟议的研究活动和方法，媒体和 与HLMSM社区和其他主要利益相关者的沟通伙伴与牢固的联系。这 项目由两个集成的研究阶段组成，重点关注五个地理区域 - 加利福尼亚州洛杉矶县； 纽约州布朗克斯县；德克萨斯州贝克萨尔县；佛罗里达州迈阿密戴德县；和圣胡安尼西比奥（PR） - 与 优先管辖权和美国HLMSM之间的大量艾滋病毒事件的重点。 在第一阶段，我们将进行形成性研究，以告知多层次数字健康的发展 干预并确定现有的本地干预措施，这些干预措施在HLMSM之间解决MM，包括（1）深度 n = 60潜水员HLMMM的访谈探讨了塑造MMT和HIV服务的根本原因和途径 使用以及概念有效性，验证和可靠性，以告知定量测量协议； （2） 焦点组（每个地理2-3），n = 6-8 hlmsm，探索可接受性和可行性和偏好 用于数字MMT干预以及参与者招聘和保留方法的观点； （3） n = 50个关键信息的访谈（艾滋病毒服务提供商，H/L社区领袖，当地民选官员） 关于他们在HLMSM，本地和组织法律/政策中的MM经验，这些经验有助于 MMT，以及HLMSM中降低MM的建议； （4）与 n = 1,625 HLMSM探索MMT和HIV服务使用的相关性。在第二阶段，我们将进行三臂 （1：1：1）并行删除随机对照试验，以评估我们的数字健康干预措施的有效性 解决HLMSM中MMT并改善现状中性艾滋病毒服务的使用。 n = 336 hlmsm将是 从五个项目地理区域（n = 1,680）中招募，并随机分配以接收 仅多级数字干预措施（交互式网络平台和可下载的干预工作簿和 工具包）或多级数字干预加上同行导航（参与者的远程医疗组件和 HLMSM同行导航器）或护理标准（转介到现有的当地艾滋病毒预防/治疗服务）。