A Pragmatic Trial of An Adaptive eHealth HIV Prevention Program for Diverse Adolescent MSM

项目摘要 青少年（13-18岁）与男性发生性关系的男性（AMSM）经历了巨大的健康差距 因为他们占年轻人的2%，但占艾滋病毒诊断的近80%。尽管如此 由于负担过重，明显缺乏以证据为基础的艾滋病毒预防方案。 执行问题至关重要，因为传统的艾滋病毒预防提供渠道（社区组织， 学校，家长），有很大的局限性，当谈到AMSM。电子保健干预措施是一种 提供AMSM具体干预材料的极好模式，青年“在哪里”。 我们不应该在参与者没有反应的情况下继续进行同样的干预。相反， 加强护理战略的强度增加，以满足那些谁不响应较低强度的需要， 干预使用序贯多分配随机试验（SMART）设计，我们将评估 已经显示出有效性的一揽子日益强化的干预措施的影响， 不同的青少年和年轻的成年男男性接触者。SMART设计是实现这一目标的理想方法 RFA，因为SMART设计模拟了在现实世界临床中做出的治疗决策 设置.我们共同将我们的电子健康干预方案命名为SMART计划（性少数群体 青少年的风险）。该计划包包括：（1）一个普遍提供的，简短的，在线性健康 为性和性别少数青年设计的教育计划，无论他们是否是性行为者， 活跃（同性恋艾德）;（2）为参与艾滋病毒的各种AMSM设计的更密集的在线干预 传播风险行为（保持下去！），（3）最密集的是动机性访谈 MI治疗师将通过在线视频聊天提供干预（青年男性健康项目）。我们将 评估SMART计划的影响，并为未来的实施提供信息，具体目标有三个。 目标1是测试SMART方案及其组成部分对减少艾滋病毒风险的影响， 增加测试。我们将使用ADAPT-ITT对AMSM的现有内容进行开发性调整 框架和语言适应SMART计划讲西班牙语的拉丁美洲AMSM。我们将招收一名 全国样本的1,878个不同的AMSM和测试的有效性，该计划使用SMART设计。 目的2是测试SMART计划是否在AMSM的重要亚组中具有不同的疗效 基于种族/民族、城市/农村、年龄、社会经济地位和语言。 目标3是在全国范围内评价SMART方案的交付情况，为方案的实施提供信息， 成本效益。为了最大限度地缩小科学与实践之间的差距，我们将利用混合方法来确定促进者 通过收集措施， 从RE-AIM框架和执行成本分析。

Project Summary Adolescent (ages 13-18) men who have sex with men (AMSM) experience a dramatic health disparity as they represent 2% of young people but account for almost 80% of HIV diagnoses. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (community organizations, schools, parents), have significant limitations when it comes to AMSM. eHealth interventions represent an excellent modality for delivering AMSM-specific intervention material where youth “are.” We should not continue to deliver the same intervention when a participant is not responding. Rather, stepped-care strategies increase in intensity to meet the needs of those who do not respond to a less intense intervention. Using a Sequential Multiple Assignment Randomized Trial (SMART) design, we will evaluate the impact of a package of increasingly intensive interventions that have already shown evidence of efficacy with diverse adolescent and young adult MSM. The SMART design is an ideal approach to achieve the goals of this RFA because SMART designs mimic treatment decisions as they are made in real-world clinical settings. Collectively we brand our package of eHealth interventions as the SMART Program (Sexual Minority Adolescent Risk Taking). The Program package includes: (1) a universally-delivered, brief, online sexual health education program designed for sexual and gender minority youth regardless of whether they are sexually active (Queer Sex Ed); (2) a more intensive online intervention designed for diverse AMSM engaging in HIV transmission risk behaviors (Keep It Up!), and (3) the most intensive is a motivational interviewing (MI) intervention that will be delivered by MI therapists via online videochat (Young Men's Health Project). We will evaluate SMART Program impact and inform future implementation with three specific aims. Aim 1 is to test impact of the SMART Program and its constituent components on reducing HIV risk and increasing testing among. We will developmentally adapt existing content for AMSM using the ADAPT-ITT framework and linguistically adapt the SMART Program to Spanish speaking Latino AMSM. We will enroll a national sample of 1,878 diverse AMSM and test the efficacy of the Program using a SMART design. Aim 2 is to test if the SMART Program has differential efficacy across important sub-groups of AMSM based on race/ethnicity, urban/rural, age, socioeconomic status, and language. Aim 3 is to evaluate the delivery of the SMART Program nationally to inform its implementation and cost-effectiveness. To minimize the science-practice gap, we will utilize mixed methods to identify facilitators and barriers to the implementation of the SMART Program and its core components by collecting measures from the RE-AIM framework and performing cost analysis.