Peer-driven Intervention to Seek, Test & Treat Heterosexuals at High Risk for HIV

描述（由申请人提供）：在美国，大约21%的艾滋病毒感染者未被诊断出来，但只有大约40%的成年人接受了检测。因此，艾滋病毒的晚期诊断很常见，而且，治疗延误和中断是普遍存在的。与其他群体相比，异性恋高危人群（HHR）接受艾滋病毒检测的可能性明显较低，被诊断出感染艾滋病毒的时间较晚的可能性更大，并且在进入护理方面面临严重障碍。我们的研究小组研究了纽约市（NYC）的HHR，作为CDC国家艾滋病毒行为监测（NHBS）研究的一部分。我们发现纽约市HHR的HIV患病率为7.4%，其中只有6%的感染者以前被诊断过。此外，在布鲁克林市中心，10%的人被新诊断为艾滋病毒感染者。拟议的研究将使用NHBS方法来针对HHR。HHR中艾滋病毒检测和治疗率的降低是由于结构性障碍（例如，难以获得）、社会障碍（例如，同伴规范）和个人层面障碍（例如，低感知风险）。因此，需要以NHBS为模型的积极招募方法来克服结构性障碍，并且同伴提供的干预措施有效地减少了个人和社会对检测和治疗的障碍。本研究的主要目的是评估多层次强化同伴驱动干预（PDI）在寻找、检测、治疗和保持HHR方面的疗效。增强型PDI专为HHR量身定制，包括计算机化、导航和同行交付组件，以增强未来的可持续性。干预的设计以三元影响理论和规范调节理论为指导。与NHBS类似，增强型PDI将使用受访者驱动抽样（RDS）。NHBS协议使用基于场地的抽样（VBS）和RDS来覆盖高危人群。然而，VBS和RDS在未确诊的HIV感染发生率方面尚未进行直接比较。因此，这项为期五年的研究的具体目的是：(1)比较RDS和VBS识别HHR中未确诊HIV感染的产量和效率；(2)在新诊断的患者中，衡量增强PDI与对照组相比在HIV护理时间和HAART启动，病毒载量抑制和滞留方面的疗效；(3)检查PDI对艾滋病毒健康/治疗结果的影响是否由个人（如感知风险）、社会（如同伴规范）和结构影响（如增强获取）的变化介导，和/或其他因素（如物质使用）是否调节其影响；(4)预测RDS相对于VBS和PDI的成本和成本效益。我们将在布鲁克林中部开展增强的PDI (N=3000)，这是一个艾滋病毒高发地区，HHR在那里很难获得检测和治疗。同时，VBS （N=400）将在布鲁克林中部进行。拟议的研究补充了地方和国家的艾滋病毒预防举措，旨在为艾滋病毒预防组合提供有效、创新和可持续的多层次招聘方法和干预。绝大多数HHR是非裔美国人或拉丁裔；因此，拟议的研究也可能影响艾滋病毒/艾滋病的种族/民族差异。

DESCRIPTION (provided by applicant): Approximately 21% of HIV infections in the U.S. are undiagnosed, but only about 40% of all adults have been tested. Thus, late diagnosis of HIV is common, and, furthermore, treatment delays and disruptions are widespread. Heterosexuals at high risk (HHR) are significantly less likely to test for HIV, are more likely to be diagnosed with HIV late, and experience serious barriers to entering care compared to other groups. Our research team has studied HHR in New York City (NYC) as part of the CDC's National HIV Behavioral Surveillance (NHBS) studies. We found an HIV prevalence rate of 7.4% among HHR in NYC, and only 6% of these infections had been previously diagnosed. Further, in central Brooklyn, 10% were newly diagnosed with HIV. The proposed study will use NHBS methodology to target HHR. Reduced rates of HIV testing and treatment among HHR are due to structural (e.g., poor access), social (e.g., peer norms), and individual-level (e.g., low perceived risk) barriers. Thus active recruitment approaches modeled after NHBS are needed to overcome structural barriers, and peer-delivered interventions effectively reduce individual and social barriers to testing and treatment. The primary goal of the proposed study is to evaluate the efficacy of a multi-level enhanced peer-driven intervention (PDI) to seek, test, treat and retain HHR. The enhanced PDI is tailored specifically for HHR and includes computerized, navigation, and peer-delivered components to enhance future sustainability. The design of the intervention is guided by the Theories of Triadic Influence and Normative Regulation. Similar to NHBS, the enhanced PDI will use respondent-driven sampling (RDS). NHBS protocols use both venue-based sampling (VBS) and RDS for reaching populations at high risk. However, VBS and RDS have not yet been directly compared in terms of their yield of undiagnosed HIV infections. Thus the specific aims of this five-year proposed study are to: (1) compare the yield and efficiency of RDS and VBS to identify undiagnosed HIV infection among HHR; (2) measure the efficacy of an enhanced PDI compared to a control in terms of time to HIV care and HAART initiation, viral load suppression, and retention among those newly diagnosed; (3) examine whether the effects of the PDI on HIV health/treatment outcomes are mediated by changes in individual (e.g., perceived risk), social (e.g., peer norms), and structural influences (e.g., enhanced access), and/or whether other factors (e.g., substance use) moderate its effects; and (4) to project the costs and cost-effectiveness of RDS vs. VBS and PDI. We will conduct the enhanced PDI (N=3000) in central Brooklyn, a location hyperendemic for HIV and where HHR experience poor access to testing and treatment. Simultaneously, VBS (N=400) will be undertaken in central Brooklyn. The proposed study complements local and national HIV prevention initiatives and is designed to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. The vast majority of HHR are African-American or Latino; therefore the proposed study may also impact racial/ethnic disparities in HIV/AIDS. PUBLIC HEALTH RELEVANCE: Heterosexuals at high risk (HHR) are significantly less likely to have been tested for HIV, do not test as frequently, and are more likely to be diagnosed with HIV late compared to other risk groups. The overarching aim of the proposed research is to develop an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. Because the vast majority of HHR are African-American or Latino, the project has great potential to reduce racial/ethnic disparities in HIV/AIDS.