PrEP Initiation and Adherence among Black SMM: A Social Network-Level Intervention

项目总结 背景资料。黑人男性的社交网络，包括黑人同性恋、双性恋和其他黑人性爱 少数族裔男子(SMM)影响他们的决策和艾滋病毒相关行为(例如，使用避孕套、艾滋病毒 测试)。社交网络策略(SNS)干预在增加艾滋病毒检测方面取得了成功 在华盛顿特区从未接受过检测且艾滋病毒状况不明的黑人SMM中(McCree et 等人，2013年；Baytop等人，2014年)。最近在华盛顿特区黑人SMM中进行的一项差异有效性研究 (在我们的帮助下进行)展示了SNS在以下方面优于场地测试和合作伙伴服务 招募从未经过测试的男性(Baytop等人，2014年)。SNS干预也绕过了结构性 暴露前预防的障碍(PrEP)，如污名、歧视和医疗不信任。建议数 这项研究的目标是设计并开放阶段试点低强度、成本效益高的SNS干预措施，以增加PrEP 在黑人SMM中印心。这一点至关重要，因为黑人SMM的艾滋病毒发病率在美国最高。 根据目前的艾滋病毒预防、治疗和护理比率，50%的黑人SMM将在他们的 与大约10%的白人SMM和25%的拉丁裔SMM相比，重要的是，这突出了一个关键的 美国公共卫生系统的失败。因此，重点预防艾滋病毒和社交网络为主 为了满足黑人SMM的独特需求，有必要采取诸如SNS之类的干预措施。 项目概述。前12个月(阶段1：形成性研究)将是一项干预 发展/适应阶段。使用基于社区的参与式方法(n=18岁--和PrEP使用 具体情况的焦点小组，每个至少4-5名参与者，总计72-90人)，参与者将被问及 社交网络动态和特征(例如，有影响力的网络成员、关于PrEP的交流 作为一种艾滋病毒预防方法)，这影响了他们启动PrEP的决定。在没有PrEP的参与者中 使用，他们将被问及与PrEP交谈的可接受性和可行性-在他们的 各自的社交网络以支持发起以及对来自 同伴们。在接下来的12个月内(第二阶段：开放试验研究)，将进行一项开放试验 SNS干预，最多六批，最多5名参与者(n=30)，允许进一步干预 精致。这将使我们能够证明参与者的可行性和接受度，其中包括以下能力 招募网络成员、实施干预的可行性、参与者行为的变化。它将允许 为进一步评估所有研究程序的可行性，完善干预手册，并提供 提交NIH申请进行更大规模预期试验的试点数据。因此，预期的结果是 与文化相关的社交网络干预，通过使用PrEP的社会干预增加黑人SMM的PrEP启动 网络成员。

PROJECT SUMMARY Background. The social networks of Black men, including Black gay, bisexual and other Black sexual minority men (SMM), influence their decision-making and HIV-related behaviors (e.g., condom use, HIV testing). Social networking strategies (SNS) interventions have been successful at increasing HIV testing among Black SMM who had never been tested and with unknown HIV status in Washington, D.C. (McCree et al., 2013; Baytop et al., 2014). A recent differential effectiveness study among Black SMM in Washington, DC (conducted at Us Helping Us) demonstrated SNS to be superior to venue testing and partner services in recruiting men that had never been tested (Baytop et al., 2014). SNS interventions also circumvent structural barriers to pre-exposure prophylaxis (PrEP) such as stigma, discrimination and medical mistrust. The proposed study aims are to design and open-phase pilot a low-intensity, cost-effective SNS intervention to increase PrEP initiation among Black SMM. This is critical because Black SMM have the highest HIV incidence in the U.S. and based on current HIV prevention, treatment and care rates, 50% of Black SMM will acquire HIV in their lifetime compared with ~10% of White SMM and 25% of Latino SMM Importantly, this highlights a critical failure of the U.S. public health system. Therefore, focused HIV prevention and social network-based intervention efforts, such as SNS, are warranted to meet the unique needs of Black SMM. Overview of project. The first 12 months (Phase 1: Formative Research) will be an intervention development/adaptation phase. Using a community-based participatory approach (n=18 age- and PrEP use profile-specific focus groups, of at least 4-5 participants each, totaling 72-90), participants will be asked about the social network dynamics and characteristics (e.g., influential network members, communication about PrEP as an HIV prevention method) that influenced their decision to initiate PrEP. Among participants with no PrEP use, they will be asked about the acceptability and feasibility of talking with PrEP-using Black SMM within their respective social network to support initiation along with preferences for relevant PrEP-related information from peers. The following 12 months (Phase 2: Open-phase Pilot Study) will involve conducting an open pilot of the SNS intervention, in up to six batches of up to 5 participants (n=30), allowing for further intervention refinement. This will allow us to demonstrate participant feasibility and acceptance, which includes the ability to recruit network members, feasibility of intervention delivery, and changes in participant behaviors. It will allow for further evaluation of the feasibility of all study procedures, refinement of intervention manual, and provide pilot data to submit an NIH application for a larger prospective trial. Therefore, the expected outcome is a culturally relevant SNS intervention to increase PrEP initiation among Black SMM through PrEP-using social network members.