Southwest Health Equity Research Collaborative

项目总结 在美国，艾滋病毒和性传播感染(STI)的发病率在 男同性恋者、双性恋者和其他与男性发生性关系的男性--这里指的是性少数男性(SMM)-- 与只与女性发生性关系的男性相比，1，2大约10%的艾滋病毒发病率可归因于 未经治疗的性传播疾病在SMM之间传播，3%的梅毒病例发生在SMM之间，4和SMM 居住在结束艾滋病毒流行(EHE)的优先司法管辖区的性传播感染的几率要高出近50% 与居住在其他地方的人相比，俄克拉何马州是一个优先考虑农村的州，年平均水平高于 衣原体感染病例，并位居全国淋病和梅毒感染前十名。在这些区域内 俄克拉荷马州社区中，24岁以下的人占新发艾滋病毒、衣原体感染和 淋病感染。不到28%的俄克拉荷马州农村人在有生之年接受过艾滋病毒检测， 去年只有5.7%，是EHE州中测试率最低的。6与他们的SMM同行类似， 美国农村印第安人(AI)男性的艾滋病毒发病率有所增加--现在AI男性占了 俄克拉荷马州9.3%的新感染者，而2016.7-2009年生活在农村地区的AI男性和SMM为7.8% 美国人不太可能收到艾滋病毒预防信息，进行常规检测，识别艾滋病毒检测 与城市同龄人相比，他们更容易获得资源，或接受全面的教育。农村SMM与人工智能 俄克拉荷马州的男性在艾滋病毒和性传播感染检测方面遇到了许多障碍，包括担心艾滋病毒相关的耻辱， 风险感知低，难以与医疗保健提供者沟通，以及保密问题，10-15 需要扩大预防和筛查服务。我们建议的研究将特别集中在两个方面 EHE支柱：诊断(即艾滋病毒筛查)和预防(即增加避孕套的使用；采用预先接触 预防)。我们的具体目标如下：目标1-完善我们的初步干预策略 与社区咨询委员会(CAB)和农村同伴导师建立伙伴关系。在为期4个月的形成期中 阶段，我们将与出租车合作，最终结束俄克拉荷马州农村地区的艾滋病毒流行(e-HERO) 要包括在初始干预原型中的组件。目标2--评估可行性、可接受性、 以及电子英雄介入的初步影响。我们将对最终的干预措施进行试点和评估 俄克拉荷马州农村使用随机对照试验设计来模仿未来在全州范围内的实施。我们会 招募农村SMM(n=100)和人工智能男子(n=100)，年龄在17-29岁。我们将使用RE-AIM19来引导 评价，这将需要对调查(SMM和AI)进行汇聚的混合方法分析 男性)、艾滋病毒/性传播感染检测记录和离职面谈，以评估可行性、可接受性和初步影响 干预行动。

PROJECT SUMMARY In the U.S., incidence rates of HIV and sexually transmitted infections (STIs) are disproportionately high among gay, bisexual, and other men who have sex with men—referred to herein as sexual minority men (SMM)— compared to men who have sex with women only.1,2 Roughly 10% of HIV incidence is attributable to increased transmission due to untreated STIs among SMM,3 64% of syphilis cases occur among SMM,4 and SMM residing in Ending the HIV Epidemic (EHE) priority jurisdictions have nearly 50% greater odds of STIs compared to those residing elsewhere.5 Oklahoma is an EHE priority rural state with above average yearly cases of chlamydia and ranks in the top 10 for gonorrhea and syphilis infections nationwide. Within these Oklahoma communities, those under the age of 24 account for a quarter of new HIV, chlamydia, and gonorrhea infections. Less than 28% of rural Oklahomans have received an HIV test during their lifetime and only 5.7% during the past year, the lowest testing rate among the EHE states.6 Similar to their SMM peers, rural American Indian (AI) men have seen an increase in HIV incidence—where the AI men now account for 9.3% of new infections in Oklahoma compared to 7.8% in 2016.7-9 AI men and SMM living in rural areas of the U.S. are less likely to receive HIV prevention messaging, engage in routine testing, identify HIV testing resources, or receive comprehensive education as compared to their urban counterparts. Rural SMM and AI men in Oklahoma experience many barriers to HIV and STI testing, including worries about HIV-related stigma, low perceptions of risk, difficulty communicating with healthcare providers, and confidentiality concerns,10-15 requiring expansion of prevention and screening services. Our proposed research will specifically focus on two EHE pillars: diagnose (i.e., HIV screening) and prevent (i.e., increase condom use; adoption of Pre-Exposure Prophylaxis). Our specific aims are as follows: AIM 1 – To refine our preliminary intervention strategy in partnership with a Community Advisory Board (CAB) and rural peer mentors. In a 4-month formative phase, we will partner with a CAB to finalize Ending the HIV Epidemic in Rural Oklahoma (e-HERO) components to be included in an initial intervention prototype. AIM 2 – To assess feasibility, acceptability, and preliminary impact of the e-HERO intervention. We will pilot and evaluate the finalized intervention in rural Oklahoma using a randomized control trial design to mimic a future statewide implementation. We will recruit rural SMM (n = 100) and AI men (n = 100) between 17-29 years of age. We will use RE-AIM19 to guide the evaluation, which will entail conducting a convergent mixed-method analysis of surveys (SMM and AI men), HIV/STI testing records, and exit interviews to assess feasibility, acceptability, and preliminary impact of the intervention.