Exploring and Intervening on Multilevel Factors of Medical Mistrust among Hispanic/Latino Gay, Bisexual and Other Men Who Have Sex with Men (HLMSM) for HIV Prevention in a Priority Jurisdiction

西班牙裔/拉丁裔同性恋、双性恋和其他与男性发生性行为的男性(HLMSM)比例不成比例 感染了艾滋病毒。医疗上的不信任与HLMSM中艾滋病毒的差异有关，因为不信任 可能导致延迟或减少使用所需的艾滋病毒预防(例如艾滋病毒检测和PrEP摄取)和护理 (例如，抗逆转录病毒治疗[抗逆转录病毒疗法])服务。人们迫切需要增加对司机的了解 医疗不信任和有效的多层次干预措施，以解决美国HLMSM中的这些驱动因素。 我们提出了一项混合方法研究，以更好地了解医疗不信任的驱动因素，并对其进行提炼和测试 旨在解决这些驱动因素并增加所需艾滋病毒预防和使用的多层次干预措施 西班牙语、英语和双语(包括西班牙语和英语，或 土著语言和/或西班牙语和/或英语)HLMSM在北卡罗来纳州梅克伦堡县的司法管辖区 以结束美国艾滋病毒流行(EHE)倡议为优先事项。 在目标1中，我们的基于社区的参与性研究(CBPR)伙伴关系将收集、分析和 解读定性和定量数据，扩大我们对医疗保险多层次驱动因素的理解 讲西班牙语、讲英语和双语的HLMSM之间的不信任。在目标2中，我们将完善一个地位- 中性、文化一致性和双语多层次干预，以解决已确定的医疗驱动因素 在讲西班牙语的人中，不信任和增加艾滋病毒检测、PrEP摄取和艾滋病毒护理服务的使用， 会说英语，会说双语的HLMSM。这一干预将基于我们之前的合作伙伴关系 以证据为基础的干预措施，并将融合基于社区的同行导航和移动健康。在《目标3》中，我们将 通过纵向分组随机设计实施和测试干预措施 评估收集时间：(1)基线，(2)干预后即刻，(3)6个月随访。我们的 假设是，参与者被随机分配到干预组，相对于他们的同行被随机分配 对于延迟干预组，将显示减少了医疗不信任和增加了艾滋病毒检测，PrEP 接受和使用艾滋病毒护理服务。我们还将对参与者进行深入访谈 和艾滋病预防护理服务提供者进行6个月的随访。 这项CBPR研究符合EHE倡议的战略、目标和目的，即国家 《艾滋病毒/艾滋病战略》和《2030年健康人》。这将增加我们对医疗事故驱动因素的理解 不信任，并将产生经过测试的地位-中立、文化一致和双语的多层次干预 对这些驱动因素进行干预，增加对艾滋病毒预防和护理服务的使用，从而可能增加 卫生公平和减少受艾滋病毒-高龄男女比例不成比例影响的人群中的差距。 调查结果将被广泛传播，为公共卫生实践、研究和促进健康的政策提供信息 公平和减少美国HLMSM之间的艾滋病毒差距。

Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) are disproportionately affected by HIV. Medical mistrust is associated with these HIV disparities among HLMSM because mistrust may result in delayed or reduced use of needed HIV prevention (e.g., HIV testing and PrEP uptake) and care (e.g., antiretroviral therapy [ART]) services. A profound need exists for increased understanding of the drivers of medical mistrust and for effective multilevel interventions to address these drivers among HLMSM in the US. We propose a mixed-methods study to better understand the drivers of medical mistrust and to refine and test a multilevel intervention designed to address these drivers and increase the use of needed HIV prevention and care services among Spanish-speaking, English-speaking, and bilingual (including Spanish and English, or an indigenous language and Spanish and/or English) HLMSM in Mecklenburg County, NC, a jurisdiction prioritized by the Ending the HIV Epidemic in the US (EHE) initiative. In Aim 1, our community-based participatory research (CBPR) partnership will collect, analyze, and interpret qualitative and quantitative data to expand our understanding of the multilevel drivers of medical mistrust among Spanish-speaking, English-speaking, and bilingual HLMSM. In Aim 2, we will refine a status- neutral, culturally congruent, and bilingual multilevel intervention to address identified drivers of medical mistrust and increase HIV testing, PrEP uptake, and use of HIV care services among Spanish-speaking, English-speaking, and bilingual HLMSM. This intervention will be based on our partnership’s previous evidence-based interventions and will blend community-based peer navigation and mHealth. In Aim 3, we will implement and test the intervention through a longitudinal group-randomized design using a quantitative assessment collected at: (1) baseline, (2) immediate post-intervention, and (3) 6-month follow-up. Our hypothesis is that participants randomized to the intervention group, relative to their counterparts randomized to the delayed-intervention group, will demonstrate reduced medical mistrust and increased HIV testing, PrEP uptake, and use of HIV care services. We also will conduct in-depth interviews with a sample of participants and HIV prevention and care service providers at 6-month follow-up. This CBPR study aligns with strategies, goals, and objectives of the EHE initiative, the National HIV/AIDS Strategy, and Healthy People 2030. It will increase our understanding of the drivers of medical mistrust and will yield a tested status-neutral, culturally congruent, and bilingual multilevel intervention to intervene on these drivers and increase use of HIV prevention and care services, thus potentially increasing health equity and reducing disparities within a population disproportionately impacted by HIV – HLMSM. Findings will be broadly disseminated to inform public health practice, research, and policy to promote health equity and reduce HIV disparities among HLMSM in the US.