Estimating the Impact of a Multilevel, Multicomponent Intervention to Increase Uptake of HIV Testing and Biomedical HIV Prevention among African?American/Black Gay, Bisexual and Same-gender Loving Men

摘要 增加获得和采用生物医学预防（PEP/PrEP）对于在非洲结束这一流行病至关重要。 同性恋、双性恋和其他与其他男性发生性关系的男性（MSM）。这是特别 城市、非洲裔美国人或黑人男男性行为者也是如此，他们不成比例地受到艾滋病毒的影响，因此 从更多的艾滋病毒检测中受益，现在建议关键群体每3-6个月进行一次检测， 治疗和预防。纽约市是美国新确诊人数最多的大都市地区， 在美国，男男性行为者和89-94%的艾滋病毒/艾滋病感染者（PLWHA）居住在城市， 地区虽然这些城市地区通常有强大的测试和PEP/PrEP传播计划，但一致的 测试和PEP/PrEP吸收是不可接受的低城市居住的黑人男男性行为者。因此需要 通过加快现有的实施工作，支持艾滋病毒检测和PEP/PrEP的采用， 传播工作。大多数艾滋病毒检测和PEP/PrEP吸收干预措施侧重于个人层面的导航 行为的系统/结构障碍和/或认知前因（意图，动机，技能）;很少关注 关于通过自我检测、赋权、同伴教育、 支持和社区规范。为了填补这一空白，我们建议测试一种干预措施， 以及由我们的研究团队设计的新型干预组件，这些组件在多个层面上运作， 纳入社区组织提供的艾滋病毒预防方案，以支持艾滋病毒检测和PEP/PrEP的吸收。我们 我将估计这些组成部分的叠加和交互效应，包括单次会议，以同伴为基础的艾滋病毒 自我测试组件，三个会话PEP/PrEP导航增强组件，以及社交和打印 反交叉污名媒体运动，采用析因和准实验设计。主 结果是艾滋病毒检测（而不是PrEP/PEP）和PrEP吸收。次要结果包括一致的 HIV检测（9个月内至少间隔3个月进行2次以上检测）; PEP摄取; PrEP/PEP依从性（自我报告/医疗 记录/尿检）。为了实现研究目标，我们将招募480名符合PrEP资格的黑人MSM（18-55岁），他们居住在 将他们随机分配到四个研究组中的一个，并随访18个月。 我们的研究代表了一个社区组织之间的合作， PEP/PrEP摄取规划和学术研究团队，旨在确定 在不同层面运作的、旨在增加个人艾滋病毒检测的组成部分， 在艾滋病毒高度脆弱群体中使用生物医学艾滋病毒预防。

ABSTRACT Increasing access to and uptake of biomedical prevention (PEP/PrEP) is critical to ending the epidemic in the United States (US) among gay, bisexual and other men who have sex with other men (MSM). This is particularly true for urban, African-American or Black MSM, who are disproportionately affected by HIV and would thus benefit from more HIV testing, which is now recommended every 3-6 months for key groups and is the gateway to treatment and prevention. NYC is the metropolitan area in the US with the largest number of newly diagnosed HIV infections among MSM and 89-94% of all people living with HIV/AIDS (PLWHA) in the US reside in urban areas. Although such urban areas often have robust testing and PEP/PrEP dissemination programs, consistent testing and PEP/PrEP uptake is unacceptably low among urban-dwelling Black MSM. There is thus a need for interventions to support both HIV testing and PEP/PrEP uptake by accelerating existing implementation and dissemination efforts. Most HIV testing and PEP/PrEP uptake interventions focus on individual-level navigation of system/structural barriers and/or cognitive antecedents (intentions, motivation, skills) to behavior; few focus on reducing stigma/discrimination-related barriers to testing/PEP/PrEP via self-testing, empowerment, peer support and community norms. To fill this gap, we propose to test an intervention composed of evidence-based and novel intervention components, designed by our study team, that operate at multiple levels and can be integrated into CBO-delivered HIV prevention programming to support HIV testing and PEP/PrEP uptake. We will estimate additive and interactive effects of the components, that include a single-session, peer-based HIV self-testing component, a three-session PEP/PrEP navigation enhancement component, and a social and print anti-intersectional stigma media campaign, using factorial and quasi-experimental designs. The primary outcomes are HIV testing (while not on PrEP/PEP) and PrEP uptake. Secondary outcomes include consistent HIV testing (2+ tests at least 3 months apart in 9 months); PEP uptake; PrEP/PEP adherence (self-report/medical record/urine test). To achieve the study aims, we will enroll 480 PrEP-eligible Black MSM (aged 18-55) living in Central Brooklyn into the study and randomize them to one of four study arms and follow them over 18 months. Our study, which represents a collaboration between a community-based organization currently engaged in PEP/PrEP uptake programming and an academic research team, is designed to identify the added value of components that operate at different levels and are designed to increase individual-level HIV testing and biomedical HIV prevention use among a group highly vulnerable to HIV.