Harnessing the power of peer navigation and mHealth to reduce health disparities in Appalachia

阿巴拉契亚地区是美国社会和经济上处于不利地位的地区，越来越多的证据表明 表明阿巴拉契亚地区与该国其他地区之间的健康差距正在扩大。同性恋、双性恋、 阿巴拉契亚农村地区的其他男男性行为者 (GBMSM) 和跨性别女性的患病率有所增加 HIV、性传播感染 (STI) 和丙型肝炎病毒 (HCV) 的风险。仍然缺乏 解决 GBMSM 和 GBMSM 之间这些新出现和交叉流行病的有效方法 生活在美国农村地区的跨性别女性。 在目标 1 中，我们基于社区的参与性研究 (CBPR) 伙伴关系建议系统地 将两种基于证据的策略（即同行导航和移动医疗）整合到一个全面的文化战略中 一致的双语干预，以增加所需的艾滋病毒、性传播感染和丙型肝炎预防和护理的使用 为阿巴拉契亚农村地区的种族/族裔多元化 GBMSM 和变性妇女提供服务。在目标 2 中，我们 将通过使用行为的纵向分组随机设计来实施和测试干预措施 评估和深入访谈数据收集于：(1) 基线，(2) 干预后立即，以及 (3) 12- 月随访。我们的假设是，相对于干预组的参与者，干预组的参与者 延迟干预组将证明 (1) HIV、STI 和 HCV 检测增加，以及 (2) 使用所需的预防服务（PrEP 和注射器服务）和护理服务（HIV 护理、STI 和 HCV） 治疗和性别确认护理）。在目标 3 中，我们将开发和传播实践、研究、 干预措施、政策重点和建议，以减少阿巴拉契亚农村地区的健康差距 举办基于赋权理论的社区论坛。 这项 CBPR 研究将通过测试创新的方法来推进预防科学和实践 干预措施，以促进和支持使用所需的艾滋病毒、性传播感染和丙型肝炎预防和护理服务 GBMSM 和跨性别女性；并制定优先事项和建议以改善其 将传播健康知识，为公共卫生实践、研究和政策提供信息。通过整合同行 导航和移动医疗策略，拟议的研究为改善健康状况提供了独特的机会 生活在阿巴拉契亚农村地区的弱势、隐藏和被忽视的人群。这项研究的结果可能 为解决其他农村人口的其他健康差距问题提供战略和方法。

Appalachia is a socially and economically disadvantaged part of the US, and growing evidence suggests that health disparities between Appalachia and the rest of the country are widening. Gay, bisexual, and other men who have sex with men (GBMSM) and transgender women in rural Appalachia are at increased risk for HIV, sexually transmitted infections (STIs), and hepatitis C virus (HCV). There remains a dearth of effective approaches to address these emerging and intersecting epidemics among GBMSM and transgender women living in rural settings in the US. In Aim 1, our community-based participatory research (CBPR) partnership proposes to systematically integrate two evidenced-based strategies (i.e., peer navigation and mHealth) into a comprehensive culturally congruent, bilingual intervention to increase the use of needed HIV, STI, and HCV prevention and care services among racially/ethnically diverse GBMSM and transgender women in rural Appalachia. In Aim 2, we will implement and test the intervention through a longitudinal group-randomized design using behavioral assessment and in-depth interview data collected at: (1) baseline, (2) immediate post intervention, and (3) 12- month follow-up. Our hypotheses are that participants in the intervention group, relative to their counterparts in the delayed-intervention group, will demonstrate (1) increased HIV, STI, and HCV testing and (2) increased use of needed prevention services (PrEP and syringe services) and care services (HIV care, STI and HCV treatment, and gender-affirming care). In Aim 3, we will develop and disseminate practice, research, intervention, and policy priorities and recommendations to reduce health disparities in rural Appalachia by conducting an empowerment theory-based community forum. This CBPR study will advance prevention science and practice through testing an innovative intervention to promote and support the use of needed HIV, STI, and HCV prevention and care services among GBMSM and transgender women; and developing priorities and recommendations to improve their health that will be disseminated to inform public health practice, research, and policy. By integrating peer navigation and mHealth strategies, the proposed study provides a unique opportunity to improve health among vulnerable, hidden, and neglected populations living in rural Appalachia. Findings from this research may inform strategies and approaches to address other health disparities in other rural populations.