Addressing Latino MSM Health Disparities by Increasing Engagement with Behavioral and HIV-Prevention Services: An Implementation Science Approach

通过增加行为和艾滋病毒预防服务的参与来解决拉丁裔男男性行为者的健康差异：一种实施科学方法

• 批准号: 10271271
• 负责人: Audrey Harkness
• 金额: $ 15.87万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10271271
• 关键词: AIDS prevention; Address; Age; Area; Automobile Driving; Behavioral; Bisexual; Caring; Clinical; Communities; Community Outreach; Data; Diagnosis; Education; Ensure; Epidemic; Face; Feedback; Financial Hardship; Focus Groups; Foundations; Funding; Gays; Goals; HIV; HIV prevention trial; HIV risk; Health; Health Services; Health system; Hispanics; Human immunodeficiency virus test; Immigrant; Immigration; Incidence; Individual; Intervention; Interview; Knowledge; Latino; Learning; Mental Health; Mentors; Mentorship; Motivation; Not Hispanic or Latino; Outcome; Pamphlets; Participant; Phase; Population; Positioning Attribute; Postdoctoral Fellow; Privatization; Problem Solving; Process; Professional counselor; Public Health; Qualitative Research; Randomized; Reporting; Research; Research Activity; Research Infrastructure; Research Training; Resources; Science; Scientific Advances and Accomplishments; Services; Sex Orientation; Sexual Health; Site; Solid; Stress; Structure; Suggestion; Surveys; Techniques; Testing; Time; Training; Trust; Work; behavior change; behavioral health; career; community partnership; cost; design; disparity reduction; effectiveness implementation study; effectiveness implementation trial; ethnic identity; evidence base; feasibility testing; health assessment; health disparity; health equity; health service use; implementation determinants; implementation efforts; implementation outcomes; implementation research; implementation science; implementation strategy; informant; men; men who have sex with men; motivational enhancement therapy; outreach; peer; pilot trial; pre-exposure prophylaxis; prevention service; psychological distress; racial and ethnic; recruit; scale up; skills; social stigma; substance use; trial comparing; uptake

PROJECT SUMMARY Miami is an HIV hotspot, driven by HIV disparities among Latino men who have sex with men (MSM). Behavioral health problems (e.g., mental health, substance use) contribute to HIV acquisition, forming synergistic disparities. Yet, Latino MSM show delayed HIV testing and underutilize pre-exposure prophylaxis (PrEP) and behavioral health services, highlighting that existing implementation efforts inadequately reach this population. My preliminary data highlight multilevel, modifiable mechanisms that drive disparities in Latino MSM’s use of PrEP, HIV testing, and behavioral health services. To advance health disparities science and achieve the Ending the HIV Epidemic goals, tailored implementation strategies that address these mechanisms to ensure the equitable delivery of PrEP, HIV testing, and behavioral health services to Latino MSM must be developed and evaluated. Research Strategy. Aim 1: Discover the key components of a culturally tailored implementation strategy that addresses the mechanisms driving Latino MSM disparities in HIV-prevention and behavioral health service use. I will leverage my preliminary data to develop a culturally tailored implementation strategy, Dime Más (“Tell Me More”) with the goal of ensuring the equitable delivery of PrEP, HIV testing, and behavioral health services to Latino MSM. From my prior work, I anticipate Dime Más will involve Latino MSM outreach workers using techniques such as motivational interviewing, problem solving, and destigmatizing narratives to engage Latino MSM in services. Results of three phases of formative research (focus groups, demonstration and feedback sessions, and a feasibility test) will be used to iteratively refine Dime Más. Aim 2: Evaluate the impact of the culturally tailored implementation strategy on Latino MSM disparities in service use. I will then conduct a pilot trial comparing Dime Más delivered by a Latino MSM outreach worker from our community partner site to standard community outreach only. Latino MSM will be randomized 1:1 to each condition (N=60, ~50% U.S. born). The trial will evaluate the impact of Dime Más on health disparities by examining PrEP, HIV testing, and behavioral health uptake across groups and exploring mechanisms of effects. We will also examine implementation outcomes (appropriateness, acceptability, feasibility, fidelity, cost) via exit interviews and surveys with participants and outreach workers. Outcomes. The proposed research and the associated training and mentoring activities will begin to elucidate the tailored strategies needed to overcome factors driving Latino MSM’s HIV and behavioral health disparities, while also building my expertise in using implementation research to advance health disparities science. With expert mentors, a strong HIV research infrastructure, solid community partnerships, and the urgent public health need to scale up PrEP, HIV testing, and behavioral health services to Latino MSM, I am well positioned to advance my research and training plan.The findings will lay the foundation for a subsequent R01 hybrid effectiveness- implementation trial, further advancing health disparities science and health equity for Latino MSM.

项目摘要 迈阿密是一个艾滋病毒热点，这是由与男性发生性关系的拉丁裔男性（MSM）之间的艾滋病毒差异造成的。 行为健康问题（例如，精神健康，物质使用）有助于艾滋病毒的获得，形成 协同差异。然而，拉丁裔男男性接触者显示艾滋病毒检测延迟，暴露前预防利用不足 （PrEP）和行为健康服务，强调现有的实施工作不足以达到这一目标。 人口我的初步数据突出了多层次的，可修改的机制，推动拉丁美洲的差异 MSM使用PrEP，HIV检测和行为健康服务。为了促进健康差距科学和 实现终止艾滋病毒流行的目标，针对这些机制制定实施战略 为了确保公平地向拉丁美洲男男性行为者提供PrEP、艾滋病毒检测和行为健康服务， 开发和评估。研究战略。目标1：发现文化定制的 实施战略，解决机制驱动拉丁美洲男男性行为者在艾滋病毒预防和 行为健康服务使用。我将利用我的初步数据， 实施战略，Dime Más（“告诉我更多”），目标是确保公平提供PrEP， 艾滋病毒检测和行为健康服务，以拉丁美洲男男性接触者。从我之前的工作来看，我预计 让拉丁裔MSM外展工作者使用诸如动机访谈，解决问题， 和去污名化的叙述，使拉丁裔男男性接触者参与服务。形成性研究三个阶段的结果 （焦点小组、演示和反馈会议以及可行性测试）将用于迭代改进 一角钱目标2：评估针对文化的实施战略对拉丁美洲男男性行为者的影响 服务使用的差异。然后，我将进行一项试点试验， 外展工作者从我们的社区合作伙伴网站，以标准的社区外展只。拉丁裔MSM将是 每种情况以1：1的比例随机分配（N=60，约50%美国出生）。该试验将评估Dime Más对 通过检查PrEP，HIV检测和行为健康摄入量， 影响机制。我们还将审查实施结果（适当性、可接受性、 可行性、忠诚度、成本），通过离职面谈和对参与者和外联工作者的调查。结果。的 拟议的研究和相关的培训和指导活动将开始，以阐明定制的 需要采取战略来克服导致拉丁美洲男男性接触者艾滋病毒和行为健康差异的因素， 建立我的专业知识，利用实施研究，以促进健康差距科学。与专家 导师，强大的艾滋病毒研究基础设施，坚实的社区伙伴关系，以及迫切的公共卫生需求 为了扩大PrEP，艾滋病毒检测和行为健康服务，以拉丁美洲男同性恋者，我有能力推进 我的研究和培训计划。研究结果将为后续R 01混合动力的有效性奠定基础- 实施试验，进一步推进拉丁美洲男男性行为者的健康差距科学和健康公平。