Technology for HIV Prevention Among Vulnerable Men in India

简介(申请人提供)：背景。男性性工作者(MSW)感染艾滋病毒的风险特别高，是在印度加强艾滋病毒/艾滋病流行的重要桥梁人群。在金奈和孟买，大多数(约60%)MSW有固定的男性或女性伴侣/配偶(HumSafar，2007；Mimiaga 2010)，因此艾滋病毒感染/传播的风险不仅来自/来自他们的性服务客户，而且来自/来自他们的主要伴侣。我们团队在人群中的经验表明，MSW通过使用手机相互联系，并与他们的客户建立网络。项目概述。这项提议是开发和试点一种新的干预措施，使用移动电话技术来减少金奈和孟买MSW的性风险。在初步形成工作之后，我们预计干预措施将结合护理标准艾滋病毒和性传播感染检测(在面对面评估期间)与行为风险降低咨询方法，使用问题解决/动机访谈，以及由研究人员通过参与者的手机发送激励提醒和降低风险提示的短信。第一阶段：前六个月将是干预发展和完善阶段。我们将首先进行定性访谈(在金奈和孟买的研究地点N=~20)和焦点小组，以告知干预的内容。然后，我们将对最多10名医务工作者(每个研究地点5名)进行干预的公开试点，并评估初步的可行性和可接受性。然后，我们将根据这些数据修改干预措施，并制定出任何剩余的方法或干预开发细节。第二阶段：未来18个月将是干预措施的随机对照试验。100名(每个研究地点80名完成者：40名)有传播或感染艾滋病毒风险的MSW将被随机分配到1)手机提供的咨询干预和护理标准艾滋病毒/性传播感染咨询和检测，或2)对照条件-单独护理艾滋病毒/性传播感染咨询和检测标准。为了最大限度地扩大概括性和可行性，我们将包括感染艾滋病毒和未感染艾滋病毒的参与者。因此，根据美印预防艾滋病毒/艾滋病和共病双边合作研究伙伴关系(R21)机制，该项目的目标之一将是确定在印度两个人口稠密的城市进行干预的结构和内容是否相似。创新。据我们所知，尽管全球手机使用量迅速增加，但在印度还没有进行过使用咨询师通过手机技术在MSW中提供艾滋病毒预防干预的研究。这将是第一次评估使用这项技术的可接受性和可行性的研究，主要是服务不足、边缘化和处于危险之中的亚群，他们已经通过手机联网。环境这一建议源于芬威健康(Fenway Health)、金奈的结核病研究中心/ICMR、孟买最大的非政府组织Gaurav/HumSafar Trust以及孟买的MSW之间正在进行的工作。芬威健康是一家非营利性社区健康中心，专门从事包括艾滋病毒/艾滋病护理和研究在内的少数性群体健康研究。 公共卫生相关性：这项建议源于芬威，一家位于波士顿的专门从事包括艾滋病毒/艾滋病护理和研究在内的性少数群体健康的非营利性社区健康中心和研究机构，以及我们在金奈结核病研究中心/印度医学研究委员会的合作者，以及孟买最大的非政府组织瓜拉夫/胡萨法尔信托基金，后者为包括男男性接触者在内的性少数群体提供护理。印度最大的两个城市金奈和孟买都有一些世界上规模最大、最集中的艾滋病毒流行。感染艾滋病毒风险最高的群体包括性工作者、男男性接触者和静脉注射吸毒者。男性性工作者感染艾滋病毒的风险特别高，是在印度加剧艾滋病毒/艾滋病流行的重要桥梁人群。在金奈和孟买，大多数(60%)男性性工作者有固定的男性或女性伴侣/配偶(HumSafar，2007；Mimiaga 2010)，因此艾滋病毒感染/传播的风险不仅来自/来自他们的性工作客户，而且来自/来自他们的主要伴侣。我们团队在人群中的经验表明，男性性工作者通过使用手机相互联系，并与他们的客户建立网络。据我们所知，尽管全球手机使用量迅速增加，但在印度，还没有进行过使用咨询师通过手机技术在男性性工作者中提供艾滋病毒预防干预的研究。这将是第一次评估使用这项技术的可接受性和可行性的研究，主要是服务不足、边缘化和处于危险之中的亚群，他们已经通过手机联网。

DESCRIPTION (provided by applicant): Background. Male sex workers (MSWs) are at particularly elevated risk for HIV infection and represent an important bridge population potentiating the HIV/AIDS epidemic in India. Most (~60%) MSWs in Chennai and Mumbai have a steady male or female partner/spouse (Humsafar, 2007; Mimiaga 2010), thus the risk for HIV-infection/transmission is not only to/from their sex work clients but also to/from their primary partners. Our team's experience with the population suggests that MSWs are networked with each other and with their clients through the use of mobile phones. Overview of project. This proposal is to develop and pilot test a new intervention that will use mobile phone technologies to reduce sexual risk taking in MSWs in Chennai and Mumbai. Following initial formative work, we anticipate that the intervention will incorporate standard of care HIV and STI testing (during in person assessments) with behavioral risk reduction counseling approaches using problem-solving/motivational interviewing, as well as text messaging of motivational reminders and for risk reduction cues delivered by study staff via participant's mobile phones. Phase 1: The first six months will be an intervention development and refinement phase. We will first conduct qualitative interviews (N = ~20 at both the Chennai and Mumbai study sites) and focus groups to inform the content of the intervention. We will then conduct an open pilot of the intervention with up to 10 MSWs (5 per study site) and assess initial feasibility and acceptability. We will then revise the intervention based on these data and work out any remaining methodological or intervention-development details. Phase 2: The next 18 months will be a RCT pilot of the intervention. One hundred (80 completers: 40 per study site) MSWs at risk for transmitting or acquiring HIV will be randomized to either 1) the mobile phone delivered counseling intervention and standard of care HIV/STI counseling and testing or 2) the control condition-standard of care HIV/STI counseling and testing alone. To maximize generalizability and feasibility, we will include both HIV-infected and HIV-uninfected participants. Accordingly, following the U.S.-India Bilateral Collaborative Research Partnerships on the Prevention of HIV/AIDS and Co-morbidities (R21) mechanism, one of the goals of the project will be to determine whether the structure and content of an intervention can be similar across two heavily populated cities in India. Innovation. To our knowledge, despite the rapid increase in mobile phone usage globally, no study has been conducted using counselors to deliver an HIV prevention intervention via mobile phone technologies in India among MSWs. This will be the first study to assess the acceptability and feasibility of using this technology, with a largely underserved, marginalized, and at risk subpopulation who are already networked through mobile phones. Environment. This proposal grew from ongoing work between Fenway Health, a non-profit community health center and research institute specializing in sexual minority health including HIV/AIDS care and research in Boston, the Tuberculosis Research Centre/ICMR in Chennai, and Gaurav/Humsafar Trust, the largest NGO providing care for sexual minorities, as well as MSWs, in Mumbai. PUBLIC HEALTH RELEVANCE: This proposal grew from ongoing work between Fenway, a non-profit community health center and research institute specializing in sexual minority health including HIV/AIDS care and research in Boston, and our collaborators at the Tuberculosis Research Centre/Indian Council of Medical Research, Chennai, and The Guarav/Humsafar Trust, the largest non-governmental organization providing care for sexual minorities, including MSM sex workers, in Mumbai. Both Chennai and Mumbai-two of the largest cities in India-have some of the largest and most concentrated HIV epidemics in the world. The groups at greatest risk for HIV include sex workers, MSM, and intravenous drug users. Male sex workers are at particularly elevated risk for HIV infection and represent an important bridge population potentiating the HIV/AIDS epidemic in India. Most (60%) male sex workers in Chennai and Mumbai have a steady male or female partner/spouse (Humsafar, 2007; Mimiaga 2010), thus the risk for HIV-infection/transmission is not only to/from their sex work clients but also to/from their primary partners. Our team's experience with the population suggests that male sex workers are networked with each other and with their clients through the use of mobile phones. To our knowledge, despite the rapid increase in mobile phone usage globally, no study has been conducted using counselors to deliver an HIV prevention intervention via mobile phone technologies in India among male sex workers. This will be the first study to assess the acceptability and feasibility of using this technology, with a largely underserved, marginalized, and at risk subpopulation who are already networked through mobile phones.