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

探索和干预西班牙裔/拉丁裔同性恋、双性恋和其他男男性行为者 (HLMSM) 中医疗不信任的多层次因素，以在优先管辖区预防艾滋病毒

• 批准号: 10794835
• 负责人: Scott D Rhodes
• 金额: $ 46.03万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 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/10794835
• 关键词: Exploring; Intervening; Multilevel; Factors; Medical

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.

西班牙裔/拉丁裔同性恋，双性恋和其他与男性发生性关系的男性（HLMSM） 受艾滋病毒感染。医学上的不信任与HLMSM中的这些艾滋病毒差异有关， 可能导致延迟或减少使用所需的艾滋病毒预防措施（例如，艾滋病毒检测和PrEP摄取）和护理 (e.g.,抗逆转录病毒疗法（ART）服务。我们非常需要加深对这些驱动因素的了解， 医疗不信任和有效的多层次干预措施，以解决这些驱动因素之间的HLMSM在美国。 我们提出了一个混合方法的研究，以更好地了解医疗不信任的驱动因素，并完善和测试 旨在解决这些驱动因素并增加所需艾滋病毒预防措施的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 北卡罗来纳州梅克伦堡县（一个管辖区） 结束美国艾滋病毒流行（EHE）倡议。 在目标1中，我们的社区参与式研究（CBPR）伙伴关系将收集，分析， 解释定性和定量数据，以扩大我们对医疗保健的多层次驱动因素的理解。 西班牙语、英语和双语HLMSM之间的不信任。在目标2中，我们将细化状态- 中立的，文化上一致的，双语的多层次干预，以解决确定的医疗驱动因素， 在讲西班牙语的人群中增加艾滋病毒检测、PrEP吸收和艾滋病毒护理服务的使用， 英语和双语HLMSM。本次干预将基于我们合作伙伴关系的先前 这将是一个基于证据的干预措施，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 实施和测试干预措施，通过纵向组随机设计，使用定量 在以下时间点收集评估：（1）基线，（2）干预后即刻，和（3）6个月随访。我们 假设被随机分配到干预组的参与者，相对于随机分配的参与者， 延迟干预组，将证明减少医疗不信任和增加艾滋病毒检测，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 和艾滋病毒预防和护理服务提供者在6个月的随访。 这项CBPR研究符合EHE倡议的战略，目标和目标，国家 艾滋病毒/艾滋病战略和2030年健康人民。它将增加我们对医疗驱动因素的理解， 不信任，并将产生一个测试的地位中立，文化一致，双语多层次的干预， 对这些驱动因素进行干预，增加艾滋病毒预防和护理服务的使用，从而有可能增加 健康公平和减少不成比例地受艾滋病毒影响的人群中的差异- HLMSM。 调查结果将被广泛传播，以告知公共卫生实践，研究和政策，以促进健康 公平和减少美国HLMSM中的艾滋病毒差异。