Accelerating PrEP Diffusion through Network Change Agents

 描述（由申请人提供）：早期证据表明，暴露前预防（PrEP）知识、PrEP寻求行为和基于种族的PrEP采用存在差异。黑人社区，特别是年轻的黑人男男性接触者（YBMSM）的PrEP参与有限。少数黑人PrEP用户的证据令人担忧，华盛顿和纽约市的PrEP客户中<15%在PrEP示范/实施项目中被确定为黑人。这一发现是在YBMSM导致这些城市（和全国）新感染的背景下。此外，全国绝大多数PrEP客户都是私人保险和老年人-这两个特征与目前的艾滋病毒发病率不一致。因此，虽然PrEP很有希望，但现实世界的PrEP使用面临着重大的实施挑战。 在过去二十年中，最广泛使用的基于网络的艾滋病毒预防干预措施是意见领袖（OL）模式或其变体，这种方法包括培训来自目标人群的受欢迎成员，通过人际传播来宣传艾滋病毒预防信息。OL模式的有效性可能受到几个因素的限制，包括：异构和重叠的网络，网络评估不足，OL的公共立场，这往往需要她/他保持符合现状。因此，识别跨否则断开连接的个体的组（下文中称为“网桥”）连接的那些人可以是使用网络信息来加速行为改变的替代且有效的方式，如已经在其他设置中所展示的。 该提案超越了传统的OL和同行外展模式，旨在根据他们在社交网络（在这种情况下是Facebook）中的结构位置招募变革推动者，以加速PrEP的传播。 该框架对于衡量桥接网络成员的潜力也非常重要，因为他们可能是最早的创新采用者，并且可能更愿意挑战现有现状。这种桥梁具有结构优势，导致工作场所环境中的沟通、创新和效率增加;然而，对公共卫生背景下的这种桥梁影响研究不足。 我们建议通过三个阶段来解决这些知识差距，并在最近两项研究的基础上进行干预。第一阶段扩展了Facebook的使用，使用PI开发和实施的混合网络数据收集方法准确地描述YBMSM网络。第二阶段根据变革推动者的结构地位（例如，桥接、中心或其它位置）。第三阶段测量和评估由相同药剂促进的PrEP扩散的三个阶段。我们的跨学科团队具有PrEP实施（施耐德），桥接指标（瓦伦特），干预培训（布里斯，希尔），社会网络分析（施耐德，瓦伦特，古德罗），伦理（Karnik）和扩散（瓦伦特，卡纳）的专业知识。拟议的研究将推进目前对PrEP创新扩散的理解，如果成功，将以YBMSM中艾滋病毒感染率惊人的方式影响城市艾滋病毒中心。

 DESCRIPTION (provided by applicant): Early evidence exists of disparities in Pre-exposure Prophylaxis (PrEP) knowledge, PrEP seeking behavior and PrEP adoption based on race. Black communities and in particular, younger Black MSM (YBMSM) have limited PrEP engagement. Evidence of few Black PrEP users is of concern with <15% of PrEP clients in Washington DC and New York City identifying as Black in PrEP demonstration/implementation projects. This finding is in the context of YBMSM leading new infections in these cities (and nationally). Furthermore, the overwhelming majority of PrEP clients nationally are privately insured and older - two characteristics incongruous with current HIV incidence. So while PrEP is promising; real-world PrEP use faces major implementation challenges. Over the past two decades, the most widely used network-based intervention for HIV prevention has been the opinion leader (OL) model or variants of it. This approach includes training popular members from a target population to promote HIV prevention messages through interpersonal communication. The effectiveness of the OL model can be limited by several factors, including: heterogeneous and overlapping networks, inadequate network assessments, and the OL's public position which often requires she/he maintain conformity to the status quo. Consequently, identifying those who connect across groups of otherwise disconnected individuals (hereafter "network bridges"), may be an alternative and efficient way to use network information to accelerate behavior change as has been demonstrated in other settings. This proposal moves beyond traditional OL and peer outreach models by aiming to recruit change agents based upon their structural position in a social network, in this case Facebook, in order to accelerate diffusion of PrEP. This framework is further important for measuring the potential of bridging network members as they may be the earliest innovation adopters and are likely to be more willing to challenge the existing status quo. Such bridges have structural advantages that have led to increased communication, innovation and efficiency in workplace settings; however, such bridging impact in public health contexts is understudied. We propose to address these knowledge gaps and intervene by building upon two recent studies through three phases. Phase I expands the use of Facebook for accurately characterizing a YBMSM network using a hybrid network data collection approach developed and implemented by the PI. Phase II identifies, recruits and trains change agents based upon their structural position (e.g., bridging, central, or other positions). Phase III measures and evaluates three stages of PrEP diffusion as promoted by the same agents. Our interdisciplinary team has expertise with PrEP implementation (Schneider), bridging metrics (Valente), intervention training (Bouris, Hill), social network analysis (Schneider, Valente, Goodreau), ethics (Karnik) and diffusion (Valente, Khanna). The proposed research will advance current understandings of diffusion of PrEP innovation and if successful, is structured to impact urban HIV epicenters with alarming rates of HIV infection in YBMSM.