Social Media Based Peer Led Intervention to Facilitate PrEP in YMSM of Color

描述（由申请人提供）：在美国，与男性发生性关系的有色人种（YMCSM，年龄在13-29岁）的新艾滋病毒感染率最高，现有的预防干预措施未能达到大多数难以达到的人群。然而，艾滋病毒预防的最新进展有望帮助扭转YMCSM中艾滋病毒感染率上升的趋势，以及艾滋病毒的总体负担。暴露前预防（PrEP）是一种由未感染艾滋病毒的人每天服用的口服抗逆转录病毒治疗方案，以防止艾滋病毒感染，已证明对降低多个高危人群的艾滋病毒感染风险有效。与此同时，年轻人（包括低收入的YMCSM）越来越普遍地使用社交媒体（如Facebook， Twitter，在线约会网站），这为识别和接触许多其他难以接触的YMCSM提供了有效的途径。这项指导职业发展奖提案的总体目标是开发和试点一种基于社交媒体的同伴主导的干预措施，以促进YMCSM对PrEP的吸收。我们将使用混合方法和“创新扩散”框架：(1)确定与YMCSM对PrEP的兴趣和采用相关的因素；(2)开发授权PrEP (E-PrEP)，这是一种基于社交媒体的同伴主导干预措施，以增加YMCSM对PrEP的接受；(3)对E-PrEP的可行性和初步效果进行中试，提高青少病患者使用和采用PrEP的意愿。在多学科专家导师团队的指导下，我将与预防措施的使用者和非采纳者进行面对面的定性访谈，以确定目前采用预防措施的促进因素和障碍。使用“创新扩散”理论框架来解释我们的发现，然后我将与YMCSM同行领导人合作开发基于社交媒体的干预措施，以促进PrEP的吸收。由此产生的E-PrEP干预将使用在线消息和由同行领导指导的讨论来提供PrEP教育，增加对PrEP使用的兴趣，并促进PrEP的获取。然后，我们将在18-29岁的YMCSM中进行E-PrEP（与暴露于在线消息和讨论促进一般健康和营养）的随机试验，以评估E-PrEP的可行性和初步效果，以提高YMCSM中自我报告的PrEP意图和吸收。我们假设，与对照组相比，随机分配到E-PrEP的参与者更有可能表达使用和使用PrEP的意图。一旦我们初步确定了E-PrEP功效的效应量，我们将提交R01申请，在多中心随机试验中测试YMCSM中的E-PrEP。在获奖期间，我将发展基于社交媒体和技术的卫生干预方面的专业知识，包括相关的道德挑战，我还将接受纵向和定性数据分析方面的高级培训。完成我计划的研究和职业发展活动将使我成为一名独立的研究者，研究新型生物行为干预措施，以改善难以接触到的人群的健康。

DESCRIPTION (provided by applicant): Young men of color who have sex with men (YMCSM, ages 13-29) experience the highest rates of new HIV infections in the U.S., with existing prevention interventions failing to reach most of this hard to reach population. Recent developments in HIV prevention, however, hold promise to help reverse the trend of rising HIV rates in YMCSM, as well as the overall burden of HIV. Pre-exposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, has demonstrated efficacy for reducing HIV acquisition risk in multiple high-risk populations. At the same time, increasingly ubiquitous use of social media (e.g. Facebook, Twitter, online dating sites) by young people, including low- income YMCSM, provides an efficient avenue to identify and reach many otherwise hard to reach YMCSM. The overall goal of this mentored career development award proposal is to develop and pilot-test a social media-based peer-led intervention to promote PrEP uptake in YMCSM. We will use mixed methods and a 'diffusion of innovation' framework to: (1) determine factors associated with interest in and adoption of PrEP among YMCSM; (2) develop Empowering with PrEP (E-PrEP), a social media-based peer-led intervention to increase PrEP uptake in YMCSM; and (3) pilot-test the feasibility and preliminary efficacy of E-PrEP for increasing intention to use and adoption of PrEP by YMCSM. With guidance from a multi-disciplinary team of expert mentors, I will conduct in-person qualitative interviews with users and non-adopters of PrEP to identify current facilitators of and barriers to its uptake. Using the 'diffusion of innovation' theoretical framework to interpret our findings, I ill then partner with YMCSM peer leaders to develop a social media-based intervention to facilitate PrEP uptake. The resulting E-PrEP intervention will use online messaging and discussions directed by peer leaders to provide education on PrEP, increase interest in PrEP use, and facilitate access to PrEP. We will then conduct a pilot randomized trial of E-PrEP (versus exposure to online messaging and discussions promoting general health and nutrition) in YMCSM ages 18-29 to assess E-PrEP's feasibility and preliminary efficacy for increasing self-reported intention in and uptake of PrEP among YMCSM. We hypothesize that, compared to a control group exposed to non-overlapping online contents focused on general health topics, participants randomized to E-PrEP will be more likely to express intention to use and to use PrEP. Once we have preliminarily determined an effect size for E-PrEP's efficacy, we will submit an R01 application to test E-PrEP among YMCSM in a multi-center randomized trial. During the award period, I will develop expertise in social media- and technology-based health interventions, including associated ethical challenges, and I will also pursue advanced training in longitudinal and qualitative data analysis. Completion of my planned research and career development activities will allow me to become an independent investigator of novel bio-behavioral interventions for improving the health of hard to reach populations.