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

阿巴拉契亚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 这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， 在阿巴拉契亚农村，其他与男性发生性关系的男性(GBMSM)和变性人女性的比例增加了 艾滋病毒、性传播感染(STI)和丙型肝炎病毒(丙型肝炎病毒)的风险。仍然缺乏 有效应对GBMSM和GBMSM之间新出现的和交叉的流行病 生活在美国农村的变性人妇女。 在目标1中，我们的基于社区的参与性研究(CBPR)伙伴关系建议系统地 将两种基于证据的战略(即同行导航和移动健康)整合为全面的文化 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 在阿巴拉契亚农村地区为不同种族的GBMSM和变性人妇女提供服务。在目标2中，我们 将通过纵向分组随机设计实施并测试干预措施 评估和深入访谈数据收集于：(1)基线，(2)干预后立即，和(3)12- 一个月的随访。我们的假设是，干预组的参与者相对于他们在 延迟干预组将显示(1)HIV、STI和丙型肝炎病毒检测增加，以及(2)增加 使用所需的预防服务(PrEP和注射器服务)和护理服务(艾滋病毒护理、性传播感染和丙型肝炎病毒 治疗和性别平等护理)。在目标3中，我们将发展和传播实践、研究、 干预措施以及政策优先事项和建议，以通过以下方式缩小阿巴拉契亚农村地区的健康差距 举办以赋权理论为基础的社区论坛。 这项CBPR研究将通过测试一种创新的 采取干预措施，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 在GBMSM和变性人妇女中；并制定优先事项和建议，以改善他们的 将传播的健康，为公共卫生实践、研究和政策提供信息。通过集成对等设备 导航和移动健康战略，拟议的研究提供了一个独特的机会，以改善 生活在阿巴拉契亚农村的弱势、隐蔽和被忽视的人群。这项研究的发现可能 提供战略和方法，以解决其他农村人口的其他健康差距。

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.