Technology for HIV Prevention Among Vulnerable Men in India

描述（由申请人提供）：背景。男性性工作者感染艾滋病毒的风险特别高，是印度艾滋病毒/艾滋病流行的重要桥梁人群。钦奈和孟买的大多数（约60%）男医务工作者有稳定的男性或女性伴侣/配偶（Humsafar，2007年; Mimiaga，2010年），因此，艾滋病毒感染/传播的风险不仅来自其性工作客户，也来自其主要伴侣。我们的团队在人口方面的经验表明，医务工作者通过使用移动的电话相互联系，并与他们的客户建立联系。项目概述。该提案旨在开发和试点测试一种新的干预措施，该措施将使用移动的电话技术来减少金奈和孟买的MSW的性风险。在初步形成性工作之后，我们预计干预措施将结合标准护理HIV和STI检测（在亲自评估期间）与行为风险降低咨询方法，这些方法使用解决问题/动机性访谈以及研究工作人员通过参与者的移动的电话提供的动机性提醒和风险降低提示的短信。第一阶段：前六个月将是干预措施的制定和完善阶段。我们将首先进行定性访谈（在钦奈和孟买研究中心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（每个研究中心5名）进行干预的开放试点，并评估初步可行性和可接受性。然后，我们将根据这些数据修改干预措施，并制定任何剩余的方法或干预措施开发细节。第2阶段：接下来的18个月将是干预的RCT试点。100名（80名完成者：每个研究中心40名）有传播或获得HIV风险的MSW将随机分配至1）移动的电话提供的咨询干预和标准护理HIV/STI咨询和检测或2）对照条件-仅标准护理HIV/STI咨询和检测。为了最大限度地提高普遍性和可行性，我们将包括HIV感染者和未感染HIV的参与者。因此，继美国-印度预防艾滋病毒/艾滋病和并发症双边合作研究伙伴关系（R21）机制，该项目的目标之一是确定印度两个人口稠密城市的干预措施的结构和内容是否相似。创新据我们所知，尽管全球移动的电话使用量迅速增加，但在印度，还没有研究使用咨询师通过移动的电话技术在MSW中提供艾滋病毒预防干预。这将是第一项评估使用这项技术的可接受性和可行性的研究，其中大部分是服务不足，边缘化和处于风险中的亚群，他们已经通过移动的电话联网。环境该提案源于芬威健康（Fenway Health）、钦奈结核病研究中心/ICMR、孟买最大的为性少数群体提供护理的非政府组织Gaurav/Humsafar Trust以及MSWs之间正在进行的工作。芬威健康是一个非营利性社区健康中心，也是波士顿专门从事性少数群体健康（包括艾滋病毒/艾滋病护理和研究）的研究机构。 公共卫生相关性：该提案源于芬威（Fenway）与我们在结核病研究中心/印度医学研究理事会（钦奈）和Guarav/Humsafar Trust（为性少数群体提供护理的最大非政府组织）之间正在进行的工作，芬威是一家非营利性社区卫生中心，也是波士顿专门研究性少数群体健康（包括艾滋病毒/艾滋病护理和研究）的研究机构。为孟买的男男性行为者性工作者提供护理。印度最大的两个城市金奈和孟买都是世界上艾滋病疫情最大、最集中的地区。感染艾滋病毒风险最大的群体包括性工作者、男男性行为者和静脉注射毒品使用者。男性性工作者感染艾滋病毒的风险特别高，是加剧印度艾滋病毒/艾滋病流行的重要桥梁人群。金奈和孟买的大多数（60%）男性性工作者有固定的男性或女性伴侣/配偶（Humsafar，2007年; Mimiaga，2010年），因此，艾滋病毒感染/传播的风险不仅来自于他们的性工作客户，也来自于他们的主要伴侣。我们的团队对人口的经验表明，男性性工作者通过使用移动的电话彼此建立联系，并与他们的客户建立联系。据我们所知，尽管全球移动的电话使用迅速增加，但在印度，还没有进行过使用咨询师通过移动的电话技术在男性性工作者中提供艾滋病毒预防干预的研究。这将是第一项评估使用这项技术的可接受性和可行性的研究，其中大部分是服务不足，边缘化和处于风险中的亚群，他们已经通过移动的电话联网。

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.