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

项目摘要/摘要： HIV 不成比例地影响西班牙裔/拉丁裔同性恋、双性恋和其他男男性行为者 (HLMSM)， 威胁到终结艾滋病毒流行 (EHE) 倡议 2030 年目标的进展。医疗不信任 (MM) 在 HLMSM 中，这与减少艾滋病毒预防和治疗服务的参与有关， 已被确定为维持和加剧艾滋病毒不平等现象的重要根源和驱动因素 HLMSM。因此，开展研究以了解和解决影响 MM 和 HIV 服务可信度的因素 （MMT）在 HLMSM 中艾滋病毒发病率升高的关键地区代表了公共卫生优先事项 推动实现国家 EHE 目标。在整个拟议项目中，HLMSM 领导的 调查小组将与由 HLMSM、具有强大能力的社区领袖组成的指导委员会合作 与西班牙裔/拉丁裔 (H/L) 社区和 HLMSM、为 HLMSM 提供服务的医疗保健提供者的社区联系， 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 项目由两个综合研究阶段组成，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 San Juan Municipio, PR — 与 EHE 是优先管辖区，并且对全美 HLMSM 的艾滋病毒发病率造成了重大负担。 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 干预并确定解决 HLMSM 中的 MM 问题的现有当地干预措施，包括 (1) 深入 采访 N=60 名不同的 HLMSM，探索塑造 MMT 和 HIV 服务的根本原因和途径 使用概念有效性、验证性和可靠性来为定量测量协议提供信息； (2) 焦点小组（每个地区 2-3 个），N=6-8 HLMSM，探索可接受性、可行性和偏好 数字 MMT 干预以及参与者招募和保留方法的观点； (3) 采访 N=50 名关键信息提供者（艾滋病毒服务提供者、H/L 社区领袖、地方民选官员） 讲述他们在 HLMSM 中使用 MM 的经验、当地和组织的法律/政策，这些法律/政策有助于 MMT，以及 HLMSM 中减少 MM 的建议； (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，用于评估我们的数字健康干预措施的有效性 解决 MMT 问题并改善 HLMSM 中状态中立的艾滋病毒服务的使用。 N=336 HLMSM 将是 从五个项目地区（总共 N=1,680）中招募并随机分配接受 仅多层次数字干预（交互式网络平台和可下载的干预工作簿以及 工具包），或多级数字干预加同行导航（远程医疗组件与参与者和 HLMSM 同行导航器），或护理标准（转介至现有的当地艾滋病毒预防/治疗服务）。

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).