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

描述（由申请人提供）：提高年轻人、非裔美国人或与男性发生性关系的黑人（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年至2009年间，男同性恋者的艾滋病毒新感染率上升了48%；最近的一项研究报告称，在男同性恋者中，每年的艾滋病毒感染率接近6%。与其他年轻男同性恋者相比，很大一部分男同性恋者在前一年没有接受过检测，而且不知道自己感染艾滋病毒的可能性是男同性恋者的7倍。与接受固定地点艾滋病毒检测相关的耻辱感使许多男同性恋者无法接受检测。此外，酒精和其他药物（AOD）的使用是在男同性恋者中预防包括检测艾滋病毒的一个重大障碍，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，设计和测试一种简短的干预措施，通过一种新颖的、与文化相关的“伙伴系统”方法，增加YBMSM中一致的艾滋病毒自我检测的吸收。在我们的模型中，同伴教育者对YBMSM（或“伙伴”）进行培训，让他们开始自我测试，并在持续的自我测试中相互支持（每3个月一次），降低性行为和AOD的使用风险。自我检测是一种很有前途的新方法，它减少了对YBMSM进行检测的几个障碍，例如艾滋病毒检测的耻辱、同性恋恐惧症、对医疗保健提供者/系统的不信任、有限的获取以及保密/隐私问题。这种简短、重点突出、量身定制的干预措施有三点

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