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

描述(由申请者提供)：提高青年、非裔美国人或黑人男男性行为者(YBMSM)的艾滋病毒检测率对于减少非裔美国人/黑人社区不成比例的疾病负担至关重要。2006至2009年间，青壮年男男性接触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，青壮年男男性接触者中的艾滋病毒年发病率接近6%。与其他年轻男男性接触者相比，很大一部分青年男男性接触者在前一年没有进行过检测，与其他年轻男男性接触者相比，他们不知道自己感染艾滋病毒的可能性要高出7倍。与进入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，酒精和其他毒品的使用是预防艾滋病毒的一个重大障碍，包括在青年男同性恋者中进行检测，这反映了复杂的社会结构，加强了耻辱和歧视的影响。我们提出了一项研究，旨在设计和测试一种简短的干预措施，以增加YBMSM对一致的HIV自我检测的接受，使用一种新颖的、与文化相关的“伙伴系统”方法。在我们的模型中，同伴教育者训练成对的YBMSM(或“伙伴”)启动自我测试，并在一致的自我测试中相互支持(每3个月)，以及性和AOD使用风险的降低。自我检测是一种很有前途的新方法，可以减少YBMSM检测的几个障碍，例如艾滋病毒检测污名、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。这项简短、有重点和量身定制的干预措施有三个方面 主要组件。首先，伙伴们将在我们的固定地点或移动检测单位获得25分钟的自我检测技能培养、增强动力和同伴支持课程、快速艾滋病毒检测和免费自我检测试剂盒。其次，将根据需要使用他们选择的交付方法交付(或访问)其他自检。第三，根据在初始会议期间制定的个性化测试计划，将使用首选类型的通信技术(例如，短信、电子邮件、电话)发送助推器信息。一名同伴教育者将提供干预，研究团队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，以确定定期艾滋病毒自我检测的障碍、促进者、感知和偏好，描述AOD使用和性行为如何影响艾滋病毒自我检测行为，并评估参与者对拟议的伙伴干预的看法。接下来，在形成性研究的基础上，我们将使用干预图谱来适应夫妻测试，结合增强的动机访谈技术来创建简短的、由同伴教育者提供的面对面干预。最后，我们将使用基于网络和应用程序的方法招募376名艾滋病毒阴性的BMSM，年龄在18至24岁之间，他们将被随机分配到干预组(技能培训；按需免费检测试剂盒；定制增强信息)或对照组(一般健康筛查信息；按需免费检测试剂盒)，并跟踪12个月，以评估干预措施在增加定期自我报告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