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).

项目概要/摘要： 艾滋病毒不成比例地影响西班牙裔/拉丁裔男同性恋、双性恋和其他男男性行为者（HLMSM）， 威胁到结束艾滋病流行（EHE）倡议2030年目标的进展。医学不信任（MM） 在HLMSM中，这与减少参与艾滋病毒预防和治疗服务有关， 艾滋病毒/艾滋病问题已被确定为维持和加剧艾滋病毒不平等的一个重要根源和驱动因素， HLMSM。因此，研究，以了解和解决因素，塑造MM和艾滋病毒服务的可信度 (MMT)在主要地区，HLMSM中艾滋病毒发病率升高代表了公共卫生的优先事项， 推动实现国家EHE目标。在整个拟议项目中， 调查小组将与指导委员会合作，指导委员会由HLMSM、社区领导人和 与西班牙裔/拉丁裔（H/L）社区和HLMSM的社区联系，为HLMSM服务的医疗保健提供者， 具有与拟议研究活动和方法相关的学科专业知识的学术合作伙伴，媒体和 与HLMSM社区和其他主要利益相关者有密切联系的沟通合作伙伴。的 该项目包括两个综合研究阶段，重点是五个地理区域-洛杉矶县，加利福尼亚州; 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PR州圣胡安市-与 EHE优先管辖区，并占美国各地HLMSM中艾滋病毒发病率的重大负担。 在第一阶段，我们将进行形成性研究，为多层次数字健康的发展提供信息。 干预措施，并确定现有的地方干预措施，以解决高级别男男性行为者中的MM，包括（1）深入 对N=60名不同的HLMSM进行访谈，探索形成MMT和HIV服务的根本原因和途径 使用以及概念的有效性，验证和可靠性，以告知定量测量协议;（2） 焦点小组（每个地理区域2-3个），N=6-8 HLMSM，探索 数字MMT干预以及参与者招募和保留方法的观点;（3） 与N=50名关键信息提供者（艾滋病毒服务提供者、H/L社区领导人、地方民选官员）的访谈 关于他们在HLMSM中与MM的经验，当地和组织的法律/政策有助于 MMT，以及在HLMSM中减少MM的建议;和（4）一项横断面在线调查， 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）平行解释性随机对照试验，以评估我们的数字健康干预措施在 解决MMT问题，并在高级别男男性行为者中改善对地位中立的艾滋病毒服务的使用。N=336 HLMSM将 从五个项目地区招募（N= 1，680），并随机分配接受 多层次数字干预（交互式网络平台和可下载的干预工作手册， 工具包），或多层次数字干预加同行导航（远程保健组件与参与者和 HLMSM同伴导航）或护理标准（转诊到现有的当地艾滋病毒预防/治疗服务）。