Expanding "Safe Spaces 4 Sexual Health," a Mobile Van HIV/STI Testing and Care Linkage Strategy, for Black MSM in online spaces

项目摘要 结束艾滋病毒流行病（EHE）取决于制定针对艾滋病毒的创新，战略和定制方法 诊断、治疗和预防。虽然新的艾滋病毒诊断已从高峰期大幅下降， 进展已经停滞，特别是在与男性发生性关系的黑人男性（MSM）中， 不成比例地影响美国。在试点研究，安全空间4性健康（SS 4SH），我们 证明了艾滋病毒/性传播感染中性检测方法的可行性和可接受性， 风险MSM在网上空间，并将他们与测试服务的移动的货车在巴尔的摩，马里兰州。专注于 在传统的寻求测试治疗策略可能会错过的在线空间中接触MSM，我们的试点达到了 151名MSM超过14个月，新诊断的艾滋病毒显著增加（7% vs. 0.5%，p<0.001） 和梅毒阳性率（10%对0.5%，p<0.001）相比，标准的护理卫生部门（HD SOC）移动的货车战略。SS 4SH试点没有评估参与者与PrEP或HIV护理的联系， EHE战略的主要支柱。拟议的R21的目的是扩大试点研究， PrEP和艾滋病毒护理联系，评估这一扩大战略的可接受性和可行性，并在准 实验设计，生成关于该策略与HD SOC相比的有效性的初步数据 移动的货车。具体目标是：1）采用基于社区的参与方法，扩大SS 4SH， 将艾滋病毒感染高风险黑人男男性行为者与PrEP联系起来，并将其与艾滋病毒护理联系起来 未确诊/未受抑制的艾滋病毒感染者，以及2）使用准实验设计，试验扩大的 SS 4SH检测加护理联系策略，以（1）评价增加护理联系的可接受性和可行性 以及（2）生成与HD SOC移动的相比扩展的SS 4 SH的有效性的初步数据 货车，定义为可达范围、检测结果的再现性和护理联系结果测量。目标1将 涉及定性的形成性工作，包括焦点小组和深入采访黑人男男性接触者和关键 与护理联系利益相关者进行知情人访谈，以探讨环境和患者层面的护理障碍 联系，并制定社区参与的联系战略，以克服这些障碍。社区咨询 委员会（CAB），由黑人男男性接触者组成，从焦点小组和面试参与者中招募，将提供 成员检查研究小组对定性数据的解释，并与研究小组合作， 在目标2试点期间，扩展SS 4SH的护理联系。在目标2中，我们将 招募男男性行为者（18-49岁）参加为期8个月的移动的货车艾滋病毒/性传播感染检测/护理联系。我们将评估结果 提供护理联系的可行性和可接受性的衡量标准，并生成关于 与HD SOC移动的货车策略相比，SS 4SH的有效性。拟议的研究具有 有可能为优先考虑黑人男男性行为者的公共卫生战略提供信息，并有可能减少艾滋病毒的传播 通过接触有感染和传播风险的人并将他们与护理联系起来，

Project Summary Ending the HIV epidemic (EHE) depends on developing innovative, strategic and tailored approaches to HIV diagnosis, treatment and prevention. While new HIV diagnoses have declined significantly from their peak, progress has stalled, particularly among Black men who have sex with men (MSM) who remain disproportionately affected in the US. In the pilot study, Safe Spaces 4 Sexual Health (SS4SH), we demonstrated the feasibility and acceptability of a status-neutral HIV/STI testing approach which identified at- risk MSM in online spaces and linked them to testing services on a mobile van in Baltimore, MD. Focusing on reaching MSM in online spaces who may be missed by traditional seek-test-treat strategies, our pilot reached 151 MSM over 14 months and demonstrated a significantly higher new HIV diagnosis (7% vs. 0.5%, p<0.001) and syphilis positivity rate (10% vs. 0.5%, p<0.001) compared to the standard of care health department (HD SOC) mobile van strategy. SS4SH pilot did not evaluate participants’ linkage to PrEP or HIV care, which are key pillars of the EHE strategy. The objective of this proposed R21 is to expand the pilot study to integrate PrEP and HIV care linkage, evaluate the acceptability and feasibility of this expanded strategy and in a quasi- experimental design, generate preliminary data on the effectiveness of this strategy compared to the HD SOC mobile van. The specific aims are: 1) Using a community-based participatory approach, expand SS4SH to incorporate linkage to PrEP for Black MSM at high risk for HIV acquisition and linkage to HIV care for those living with undiagnosed/unsuppressed HIV, and 2) Using a quasi-experimental design, pilot the expanded SS4SH testing plus care linkage strategy to (1) evaluate the acceptability and feasibility of adding care linkage and (2) generate preliminary data on effectiveness of the expanded SS4SH compared to the HD SOC mobile van as defined by reach, reproducibility of testing outcomes, and care linkage outcome measures. Aim 1 will involve qualitative formative work including focus groups and in-depth interviews with Black MSM and key informant interviews with care linkage stakeholders to explore environmental and patient level barriers to care linkage and develop community engaged linkage strategies to overcome these barriers. A community advisory board (CAB), composed of Black MSM recruited from focus group and interview participants will provide member-checking of the study team’s interpretations of qualitative data and partner with the study team to develop the expansion of SS4SH for care linkage to be implemented during the Aim 2 pilot. In Aim 2, we will recruit MSM (ages 18-49) for mobile van HIV/STI testing/care linkage over 8 months. We will evaluate outcome measures of feasibility and acceptability of providing care linkage and generate preliminary data on the effectiveness of the SS4SH compared to the HD SOC mobile van strategy. The proposed research has the potential to inform public health strategies prioritizing Black MSM and potentially reduce ongoing HIV disparities by reaching both those at risk for acquisition and transmission and linking them to care.