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岁至25岁的年轻人占新感染病例的25%以上，其中大多数病例发生在年轻的男男性行为者(YMSM)中。虽然官方的发病率统计数据没有按变性人的身份进行区分，但当地估计表明，年轻的变性人妇女(YTW)中未被识别的艾滋病毒感染率极高。物质使用，特别是酒精滥用，已被确定为性风险的驱动因素和潜在的障碍 在基督教青年会和青年妇女中间开展艾滋病毒预防和护理(即寻求、检测、治疗、保留)，但这些青年很难获得药物使用服务，部分原因是处于边缘地位和获得保健的机会很少。然而，基督教青年会和基督教青年会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。作为参与整个艾滋病毒预防和护理连续体的全面护理的潜在切入点，这些环境没有得到充分利用，现在已扩展到对艾滋病毒阴性的高危青年使用暴露前预防措施。为了利用这一机会，我们建议通过将药物使用筛查和短暂干预整合到传统的以社区为基础的艾滋病毒检测环境中，测试对寻求、检测、治疗和保留(STTR)模式的结构性变化。我们将在艾滋病毒检测时将STTR与物质使用的筛查和简短干预(SBI)结合起来，使SBI适应针对YMSM和YTW的社区环境中的电子部署(ESBI)。本研究的目的是在芝加哥以社区为基础的HIV检测环境中，与仅在YMSM和YTW中使用STTR(对照)相比，测试ESBI结合STTR(干预)的可行性、可接受性和初步效果，并评估和描述干预对HIV和PrEP护理连续体中参与的影响。我们的目标如下：目标1：评估在芝加哥的450名16-25岁的YMSM和YTW中，采用电子筛查和简短干预(ESBI)+寻求、测试、治疗和保留(STTR)方案减少酒精和其他物质使用的可行性、可接受性和初步疗效；目标2：探讨ESBI+STTR方案与STTR方案相比在YMSM和YTW的HIV和PrEP护理连续体系中的二次探索性结果。拟议的研究对RFA-DA-15-019做出了高度响应，试图在研究不足的人群和高危人群中测试艾滋病毒护理连续体中物质使用的经验性干预措施。总而言之，研究小组在履行机构以及目标人群--基督教青年会和青年会--方面拥有丰富的经验，能够有效地让他们参与拟议的研究。研究结果有可能改变这些艾滋病毒感染高危青年的艾滋病毒检测模式的结构，将物质使用筛查和干预嵌入到传统的艾滋病毒检测环境中，在可推广到社区背景的可移植和可重复的框架内。

 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.