Employing eSBI in a Community-based HIV Testing Environment for At-risk Youth

 描述（由申请人提供）：最近对美国艾滋病毒发病率的估计表明，13至25岁的年轻人占新感染人数的25%以上，其中大多数病例发生在男男性行为（YMSM）的年轻男性中。虽然官方的发病率统计数据没有按变性人身份区分，但当地的估计数字表明，年轻变性妇女中未被确认的艾滋病毒感染率极高。药物使用，特别是酒精滥用，已被确定为性风险的驱动因素和潜在障碍 参与艾滋病毒预防和护理的连续性（即，在YMSM和YTW中，寻求、测试、治疗、保留），但这些青年很难获得药物使用服务，部分原因是边缘化地位和难以获得医疗保健。然而，YMSM和YTW经常在社区和外展环境中寻求艾滋病毒检测和其他支助服务。这些环境作为参与整个艾滋病毒预防和护理连续体的综合护理的潜在切入点没有得到充分利用，现在已扩展到对高风险艾滋病毒阴性青年使用暴露前预防。为了利用这一机会，我们建议通过将物质使用筛查和短暂干预纳入传统的以社区为基础的艾滋病毒检测环境，对寻求、检测、治疗和保留（STTR）模式进行结构性改革。我们将在艾滋病毒检测时将STTR与药物使用筛查和简短干预（SBI）结合起来，在以YMSM和YTW为目标的社区环境中调整SBI用于电子部署（eSBI）。本研究的目的是在芝加哥的社区艾滋病毒检测环境中，在YMSM和YTW中测试与STTR（干预）相结合的eSBI与STTR（对照）的可行性、可接受性和初步疗效，并评估和描述干预对艾滋病毒和PrEP护理连续体参与的影响。我们将这样做的目的如下：目的1：评估电子筛查和简短干预（eSBI）+寻求，测试，治疗和保留（STTR）与STTR相比的可行性，可接受性和初步疗效，以减少芝加哥450名16-25岁的YMSM和YTW中的酒精和其他物质使用;目的2：在YMSM和YTW中，探索eSBI+STTR与仅STTR相比对HIV和PrEP护理连续体中次要探索性结局的初步疗效。拟议的研究对RFA-DA-15-019具有高度响应性，旨在测试研究不足和高风险人群中HIV护理连续体中药物使用的药物干预措施。总之，研究团队在SBI以及目标人群YMSM和YTW方面拥有丰富的经验，可以有效地让他们参与拟议的研究。研究结果有可能改变艾滋病毒检测模式的结构，这些青年在艾滋病毒感染的高风险，嵌入物质使用筛查和干预到传统的艾滋病毒检测环境中，在一个便携式和可重复的框架，是普遍的社区为基础的情况。

 DESCRIPTION (provided by applicant): Recent estimates of U.S. HIV incidence indicate that young people aged 13 to 25 account for more than a 25% of new infections, with the majority of cases among young men who have sex with men (YMSM). While official incidence statistics are not differentiated by transgender status, local estimates indicate extremely high rates of unrecognized HIV infection among young transgender women (YTW). Substance use, particularly alcohol misuse, has been identified as a driver of sexual risk and a potential barrier to engagement in the HIV prevention and care continuum (i.e., Seek, Test, Treat, Retain) among YMSM and YTW, but these youth are difficult to reach for substance use services due in part to marginalized status and poor access to health care. YMSM and YTW, however, often seek HIV testing and other supportive services in community-based and outreach settings. These settings are underutilized as potential entry points for engagement in comprehensive care across the HIV prevention and care continuum, which now extends to the use of pre-exposure prophylaxis (PrEP) for high risk HIV-negative youth. To capitalize on this opportunity, we propose to test a structural change to the Seek, Test, Treat and Retain (STTR) model by integrating substance use screening and brief intervention into the traditional community-based HIV testing environment. We will couple STTR with Screening & Brief Intervention (SBI) for substance use at the point of HIV testing, adapting SBI for electronic deployment (eSBI) in community-based environments that target YMSM and YTW. The purpose of this study is to test the feasibility, acceptability and initial efficacy of eSBI coupled with STTR (intervention) in comparison to STTR only (control) among YMSM and YTW in community-based HIV testing environments in Chicago and to assess and describe intervention effects on engagement within the HIV and PrEP care continuum. We will do this with the following aims: Aim 1: Assess the feasibility, acceptability and initial efficacy of electronic Screening & Brief Intervention (eSBI)+ Seek, Test, Treat and Retain (STTR) compared to STTR-only to reduce alcohol and other substance use among 450 YMSM and YTW in Chicago, ages 16-25; Aim 2: To explore the initial efficacy of eSBI+STTR in comparison to STTR-only on secondary exploratory outcomes within the HIV and PrEP care continuum among YMSM and YTW. The proposed study is highly responsive to RFA-DA-15-019 by seeking to test empirically-based interventions for substance use within the HIV care continuum among understudied and high-risk populations. Together, the research team has substantial experience with SBI as well as the target populations, YMSM and YTW, to effectively engage them in the proposed research. Study findings have the potential to change the structure of the HIV testing paradigm for these youth at high risk of HIV infection by imbedding substance use screening and intervention into the traditional HIV testing environment, within a portable and reproducible framework that is generalizable to community-based contexts.