An RCT to train Black MSM as peer health educator for HIV testing and prevention

一项随机对照试验，旨在培训黑人男男性接触者作为艾滋病毒检测和预防的同伴健康教育者

• 批准号: 8138819
• 负责人: CARL A LATKIN
• 金额: $ 69.25万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8138819
• 关键词: AIDS prevention; Address; Advocacy; Affect; Alcohol or Other Drugs use; Area; Attention; Baltimore; Behavior; Behavior Therapy; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical Trials Design; Cocaine Users; Communities; Counseling; Crack Cocaine; Data; Diffuse; Diffusion; Drug usage; Effectiveness; Enrollment; Evaluation; Experimental Designs; Funding; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Health Educators; Health Promotion; Health education; Human immunodeficiency virus test; Illicit Drugs; Incidence; Individual; Intervention; Longitudinal Studies; Mediating; Medical; Mental Depression; Methamphetamine; Network-based; Opiates; Outcome; Participant; Prevalence; Prevention program; Preventive; Preventive Intervention; Process; Randomized; Randomized Clinical Trials; Recruitment Activity; Reporting; Research; Research Personnel; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Role; Sample Size; Sampling; Sexual Partners; Social Environment; Social Network; Surveys; System; Testing; Time; Training; Work; base; cost; design; flexibility; follow-up; improved; indexing; member; men; men who have sex with men; metropolitan; non-drug; novel; peer; programs; public health emergency; sex risk; social

DESCRIPTION (provided by applicant): In the US, the highest rates of HIV infection are among Black men who have sex with men (MSM). According to the CDC National HIV Behavioral Surveillance system (NHBS) in 2004-5, Baltimore had the highest HIV rates among Black MSM with prevalence of 51% and an incidence rates estimated to be 8% per year. In the 2008 NHBS survey of Black MSM, 45% were positive. There is also an alarmingly high rate of seropositive Black MSM who are not aware of their positive HIV status. The percent of positive Black MSM in the Baltimore NHBS survey who reported that they were unaware of their serostatus was 64% in 2004-5 and 77% in 2008. There is a dearth of Interventions that have demonstrated efficacy or effectiveness in reducing HIV risk behaviors among Black MSM. Many researchers have documented the importance of developing and tailoring HIV prevention programs to issues unique to Black MSM. Based on the process evaluation findings from our recent pilot HIV prevention intervention for Black MSM and using a randomized clinical trial design, we plan to randomize 360 Black MSM to either a 6-session Peer Health Educator intervention condition or an equal attention control condition. We have designed the experimental intervention to provide Black MSM an opportunity to perform a positive social role of peer health educator. This role allows for HIV preventive advocacy and practices without focusing on stigmatizing identities or behaviors, such as HIV seropositive or current drug use status. The primary goal of the proposed intervention is to increase HIV risk reduction among Black MSM and increase VCT, risk reduction, and access to HIV medical care among their risk network members. Peer Health Educators will be encouraged to recruit up to 5 sex partners and other Black MSM for VCT. The first 2 network members who receive VCT will be invited to the longitudinal study. It is anticipated that on average 1.5 risk network members will enroll in the longitudinal study. Thus, the sample will be 360 Index participants and 540 network members. We will follow-up both index and network participants' in six- month intervals for 18 months. The main outcomes will be HIV sexual risk behaviors and number of network members recruited for VCT. Mediating social environmental and individual level factors will also be assessed. As illicit drug use among Black MSM is a risk factor for HIV and there are high rates of drug use among MSM in Baltimore, we propose stratifying recruitment by drug use, with half of the index participants being current users of cocaine, crack, methamphetamines or non-prescription opiates. PUBLIC HEALTH RELEVANCE: There is an urgent need for effective behavioral interventions for HIV prevention, testing, and medical care for Black MSM. The proposed intervention is designed to promote and diffuse HIV risk reduction and VCT and reach a diverse group of Black MSM and their risk partners. This intervention has been designed to be low cost, sustainable, and feasible for health departments and community-based organizations to implement. It is also designed to be culturally appropriate for Black urban MSM and their network members.

描述（由申请人提供）：在美国，艾滋病毒感染率最高的是男男性行为者 (MSM) 的黑人男性。根据 CDC 国家 HIV 行为监测系统 (NHBS) 2004 年 5 月的数据，巴尔的摩的黑人 MSM 感染率最高，患病率为 51%，每年发病率估计为 8%。在 2008 年 NHBS 对黑人 MSM 的调查中，45% 呈阳性。黑人 MSM 血清反应阳性率也高得惊人，他们并不知道自己的 HIV 阳性状况。在巴尔的摩 NHBS 调查中，2004 年 5 月报告不知道自己血清状态的阳性黑人 MSM 的百分比为 64%，2008 年为 77%。缺乏已证明在减少黑人 MSM 中艾滋病毒危险行为方面有效或有效的干预措施。许多研究人员已经证明了针对黑人 MSM 特有问题制定和定制艾滋病毒预防计划的重要性。根据我们最近针对黑人 MSM 的试点 HIV 预防干预的过程评估结果，并使用随机临床试验设计，我们计划将 360 名黑人 MSM 随机分配到 6 节同伴健康教育者干预条件或同等注意力控制条件。我们设计了实验干预措施，为黑人男男性接触者提供发挥同伴健康教育者积极社会作用的机会。这一角色允许艾滋病毒预防宣传和实践，而不必关注污名化的身份或行为，例如艾滋病毒血清阳性或当前的吸毒状况。拟议干预措施的主要目标是增加黑人男男性接触者中艾滋病毒风险的降低，并增加其风险网络成员中的 VCT、风险降低和获得艾滋病毒医疗护理的机会。将鼓励同伴健康教育者招募最多 5 名性伴侣和其他黑人 MSM 进行 VCT。前 2 名接受 VCT 的网络成员将被邀请参加纵向研究。预计平均有 1.5 名风险网络成员将参加纵向研究。因此，样本将包括 360 名指数参与者和 540 名网络成员。我们将在 18 个月内以六个月为间隔对指数和网络参与者进行跟踪。主要结果将是艾滋病毒性危险行为和招募参加 VCT 的网络成员数量。还将评估调节社会环境和个人水平因素。由于黑人 MSM 中非法药物使用是艾滋病毒的危险因素，而且巴尔的摩 MSM 中的药物使用率很高，因此我们建议按药物使用情况进行分层招募，其中一半的指数参与者是可卡因、强效快克、甲基苯丙胺或非处方阿片类药物的当前使用者。 公共卫生相关性：迫切需要对黑人 MSM 进行有效的行为干预，以预防、检测和医疗护理。拟议的干预措施旨在促进和推广艾滋病毒风险降低和 VCT，并惠及黑人 MSM 及其风险伴侣等多元化群体。该干预措施的设计成本低、可持续且对于卫生部门和社区组织来说是可行的。它还旨在在文化上适合黑人城市 MSM 及其网络成员。