Testing an Intervention to Increase HIV Self-Testing among Young, Black MSM

描述（由申请人提供）：增加年轻人，非洲裔美国人或黑人男性之间的艾滋病毒检测率与男性发生性关系（YBMSM）是减少非洲裔美国人/黑人社区不成比例的疾病负担的关键。2006年至2009年，在青年、双性恋和变性者中，新的艾滋病毒感染率增加了48%;最近的一项研究报告说，青年、双性恋和变性者中艾滋病毒年发病率接近6%。很大一部分YBMSM在前一年没有进行过检测，与其他年轻的MSM相比，YBMSM不知道自己感染艾滋病毒的可能性高出7倍。与获得固定地点艾滋病毒检测相关的耻辱阻止了许多YBMSM进行检测。此外，在YBMSM中，酒精和其他药物的使用是艾滋病毒预防，包括检测的一个重大障碍，反映了复杂的社会结构，加剧了耻辱和歧视的影响。我们提出了一项研究，设计和测试一个简短的干预措施，以增加摄取一致的艾滋病毒自我检测YBMSM之间使用一种新的和文化相关的“伙伴系统”的方法。在我们的模型中，同伴教育者训练成对的YBMSM（或“伙伴”）开始自我测试，并在一致的自我测试（每3个月）和性和AOD使用风险降低中相互支持。自我测试是一种很有前途的新方法，它减少了对YBMSM进行测试的几个障碍，例如艾滋病毒测试耻辱，同性恋恐惧症，对医疗保健提供者/系统的不信任，有限的访问，以及保密/隐私问题。干预措施简短、重点突出、量身定制， 主要成分。首先，伙伴们将在我们的固定站点或我们的移动的测试单位接受25分钟的自我测试技能建设、动机增强和以同伴支持为重点的会议、快速艾滋病毒测试和免费的自我测试套件。第二，额外的自测将根据需要使用他们选择的交付方法交付（或访问）。第三，基于在初始会话期间开发的个性化测试计划的助推器消息将使用优选类型的通信技术（例如，文本、电子邮件、电话）。同伴教育者将提供干预措施，研究小组将使用全方位的通信技术提供按需技术支持。作为研究的一部分，我们建议进行30次深入访谈，以确定定期HIV自我检测的障碍、促进因素、看法和偏好，描述AOD使用和性行为如何影响HIV自我检测行为，并评估参与者对拟议的伙伴干预的看法。接下来，基于形成性研究，我们将使用干预映射来调整夫妻测试，整合增强的动机访谈技术，以创建一个简短的，同伴教育者提供的，面对面的干预。最后，我们将使用基于网络和应用程序的方法招募376名年龄在18至24岁之间的HIV阴性BMSM，他们将被随机配对到任何一个干预组（技能培训;按需提供免费测试包;量身定制的助推器信息）或控制臂（一般健康检查资料;免费检测试剂盒），并随访12个月，以评估干预措施在增加定期自我报告的艾滋病毒自我检测方面的有效性

DESCRIPTION (provided by applicant): Increasing HIV testing rates among young, African American or Black men who have sex with men (YBMSM) is critical to reducing the disproportionate disease burden in the African American/Black community. Rates of new HIV infections increased 48% between 2006 and 2009 among YBMSM; a recent study reported a nearly 6% annual HIV incidence among YBMSM. A significant portion of YBMSM has not tested in the prior year and YBMSM are 7 times more likely to be unaware of their HIV infection, as compared to other young MSM. The stigma associated with accessing fixed site HIV testing prevents many YBMSM from testing. In addition, alcohol and other drug (AOD) use represent a significant barrier to HIV prevention, including testing, among YBMSM, reflecting complex social structures, enhancing the impact of stigma and discrimination. We propose a study to design and test a brief intervention to increase uptake of consistent HIV self-testing among YBMSM using a novel and culturally-relevant "buddy system" approach. In our model, peer educators train pairs of YBMSM (or "buddies") to initiate self-testing and support each other in consistent self-testing (every 3 months) and sexual and AOD use risk reduction. The self-test is a promising new method that reduces several barriers to testing for YBMSM, such as HIV testing stigma, homophobia, mistrust of medical care providers/system, limited access, and confidentiality/privacy concerns. The intervention, which is brief, focused and tailored, has three primary components. First, buddies will receive a 25-minute self-testing skills-building, motivation- enhancing and peer support-focused session, rapid HIV testing and free self-test kits at our fixed site or on our mobile testing unit. Second, additional self-tests will be deliverd (or accessed) as needed, using the delivery method of their choice. Third, booster messages, based on personalized testing plans developed during the initial session, will be delivered using preferred type of communication technology (e.g., texts, e-mail, calls). A peer educator will deliver the intervention and on-demand technical support will be available from the study team using the full range of communication technology. As part of the study, we propose to conduct 30 in- depth interviews to identify barriers to, facilitators of, perceptions of and preferences fo regular HIV self- testing, describe how AOD use and sexual behavior influence HIV self-testing behaviors, and assess participant perspectives on the proposed buddy intervention. Next, based on the formative research, we will use intervention mapping to adapt couples testing, integrating enhanced motivational interviewing techniques to create a brief, peer educator-delivered, face-to-face intervention. Finally, we will use web- and app-based approaches to recruit 376 HIV-negative, BMSM aged 18 to 24 who will be randomized as pairs to either the intervention arm (skills training; free test kits on demand; tailored booster messages) or the control arm (generic health screening information; free test kits on demand) and followed for 12 months to estimate the intervention's efficacy in increasing regular self-reported HIV self-testing