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PrEP采用基于种族存在差异。黑人社区，特别是年轻的黑人MSM(YBMSM)，参与PrEP的程度有限。在华盛顿特区和纽约市，有15%的PrEP客户在PrEP演示/实施项目中标识为黑人，这是令人担忧的，因为很少有黑人PrEP用户。这一发现是在YBMSM在这些城市(和全国)导致新感染的背景下得出的。此外，全国绝大多数PrEP客户都是私人保险和年龄较大的客户--这两个特征与目前的艾滋病毒发病率不符。因此，尽管PrEP前景看好，但在现实世界中，PrEP的使用面临着重大的实施挑战。在过去的二十年里，最广泛使用的基于网络的艾滋病毒预防干预一直是意见领袖(OL)模式或其变体。这一方法包括培训目标人群中受欢迎的成员，通过人际交流宣传预防艾滋病毒的信息。OL模式的有效性可能受到几个因素的限制，包括：异质和重叠的网络、不充分的网络评估以及OL的公开立场，这往往要求她/他保持现状。因此，如在其他设置中已经展示的那样，识别那些跨以其他方式断开的个体的群组连接的人(以下称为“网桥”)可能是使用网络信息来加速行为改变的替代且有效的方式。这一提议超越了传统的OL和同行外联模式，旨在根据他们在社交网络中的结构地位招募变革推动者，在这种情况下是Facebook，以加快PrEP的传播。这 框架对于衡量搭桥网络成员的潜力更加重要，因为他们可能是最早采用创新的人，而且可能更愿意挑战现有的现状。这种桥梁具有结构性优势，从而增加了工作场所的沟通、创新和效率；然而，这种桥梁在公共卫生背景下的影响尚未得到充分研究。我们建议通过分三个阶段在最近两项研究的基础上解决这些知识差距并进行干预。第一阶段扩大了Facebook的使用，利用由PI开发和实施的混合网络数据收集方法准确地描述YBMSM网络的特征。第二阶段根据变革推动者的结构地位(例如，桥梁、中心或其他岗位)确定、招募和培训变革推动者。第三阶段测量和评估由相同试剂促进的PrEP扩散的三个阶段。我们的跨学科团队在PrEP实施(施耐德)、桥接指标(瓦伦特)、干预培训(布里斯、希尔)、社交网络分析(施耐德、瓦伦特、古德罗)、伦理学(卡尼克)和传播(瓦伦特、卡纳)方面拥有专业知识。这项拟议的研究将推进目前对PrEP创新扩散的理解，如果成功，将以令人震惊的YBMSM艾滋病毒感染率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.