Brief, web-based intervention to reduce heavy drinking and encourage prevention among high-risk men completing HIV/STI self-testing

项目摘要/摘要 在美国，男男性行为者中新感染艾滋病毒的比率保持稳定 (男男性接触者)近年来，尽管大多数其他高危人群有所下降，突显出继续需要 男男性接触者预防的创新方法。饮酒是男男性接触者感染艾滋病毒的主要危险因素， 部分原因是大量饮酒会增加发生可传播艾滋病毒的性行为的几率。 我们的研究还表明，大量饮酒的人不太可能在疾控中心内进行艾滋病毒检测--推荐 间隔时间。这种程度的饮酒在MSM中很常见，高达40%的人报告说过去曾大量饮酒 月份。以家庭为基础的艾滋病毒和性传播感染自我检测是鼓励定期检测的一种很有前途的战略。常规 检测可以帮助更早地发现更多新感染，防止进一步感染，并提高死亡率。 尽管自我检测有希望，但人们对提供支持的最佳方式以及艾滋病毒/性传播感染自我检测知之甚少 测试程序。尽管目前的许多自我测试计划为接受者提供了24小时 他们可以拨打求助热线寻求咨询和转介，很少有人使用这项服务。提供的咨询服务也很少 由理论提供信息，通常没有解决维持风险的关键因素，如酒精使用。基于网络的， 简单的干预可能是一种非常适合在提供这些计划和 可以帮助参加这些计划的男男性接触者减少饮酒并开始使用艾滋病毒预防措施 有效的方法。在之前的支持下，我们开发了游戏计划，这是一个互动的、响应性的网站 应用程序模仿以证据为基础的简短动机干预。它旨在帮助高风险、 大量饮酒的男男性接触者在接受检测时考虑减少酗酒和性行为风险 爱滋病毒。在一项对40名酗酒、高危MSM的初步研究中，那些在HIV检测后使用Game Plans的人 报告称，酗酒天数减少了24%，酗酒问题减少了17%，新的肛交伴侣减少了50%，以及 在三个月的随访期内，高危无套管性行为(CAS)与对照组相比减少了12%。 拟议的研究包括进行一项更大规模的研究，探索游戏计划在 现实世界，以及扩大艾滋病毒检测的创新方法。使用混合1效能- 实施办法，我们将在网上招募360名高危、酗酒的男男性接触者从几个高发人群中 美国一些地区参加一项计划，定期通过邮件提供以家庭为基础的艾滋病毒/性传播感染自我检测 间隔超过一年(基线，6个月，12个月)。参与者将被随机分配以获得访问权限 或者(1)24小时帮助热线咨询/转介，或(2)帮助热线+游戏计划。我们将测试一下 与使用游戏计划的人相比，使用游戏计划的人酗酒、任何性传播感染和高危CAS事件的发生率都较低 给那些只接受求助热线的人。混合方法也将用于游戏计划 用户(N=30)和测试外联计划利益相关者(N=12)，以开始了解关键实施 这些结果可以指导我们设计战略，将游戏计划落实到艾滋病毒/性传播感染检测项目中。

Project Summary/Abstract In the United States, rates of new HIV infections have remained stable among men who have sex with men (MSM) in recent years despite declines among most other at-risk groups, highlighting the continued need for innovative approaches to prevention for MSM. Alcohol use is a major risk factor for HIV infection among MSM, in part due to the tendency for heavy drinking to increase the odds of engaging in sex that can transmit HIV. Our work has also shown that heavy drinkers are less likely to have tested for HIV within CDC-recommended intervals. This level of drinking is common among MSM, with up to 40% reporting heavy drinking in the past month. Home-based HIV and STI self-testing is a promising strategy for encouraging regular testing. Regular testing can help detect more new infections earlier, preventing onward infections and improving mortality. Despite self-testing’s promise, little is known about the best ways to provide support alongside HIV/STI self- testing programs. Although many current self-testing programs provide recipients with access to a 24-hour helpline they can call for counseling and referrals, few use this service. The counseling provided is also rarely informed by theory and often does not address key factors that maintain risk, like alcohol use. Web-based, brief interventions may be one approach that is well-suited to provide support alongside these programs and could help MSM participating in these programs to reduce their alcohol use and begin using HIV prevention methods that work. With previous support, we developed Game Plan, an interactive, responsive web application modeled after evidence-based brief motivational interventions. It is designed to help high-risk, heavy drinking MSM consider reducing their binge drinking and sexual risk behavior when they get tested for HIV. In a preliminary study of 40 heavy drinking, high-risk MSM, those who used Game Plan after HIV testing reported 24% fewer binge drinking days, 17% fewer alcohol problems, 50% fewer new anal sex partners, and 12% fewer high-risk condomless sex (CAS) acts compared to controls over a three-month follow-up period. The proposed study involves conducting a larger-scale study exploring Game Plan’s effects among MSM in the real-world, alongside innovative approaches for expanding HIV testing. Using a hybrid 1 effectiveness- implementation approach, we will recruit 360 high-risk, heavy drinking MSM online from several high-incidence areas in the US to participate in a program providing home-based HIV/STI self-tests in the mail at regular intervals over a year (baseline, 6 months, 12 months). Participants will be randomly assigned to receive access to either (1) a 24-hour helpline for counseling/referrals, or (2) the helpline plus Game Plan. We will test whether those who use Game Plan show lower rates of heavy drinking, any STIs, and high-risk CAS events compared to those receiving access to the helpline alone. Mixed-methods approaches will also be used with Game Plan users (N=30) and testing outreach program stakeholders (N=12) to begin understanding key implementation outcomes that can guide us in designing strategies for implementing Game Plan into HIV/STI testing programs.