Developing and Pilot Testing a Mobile Phone-Based HIV/STI Prevention Intervention

描述（由申请人提供）：本提案是为了应对与男性发生性关系（MSM）的年轻非洲裔美国人中艾滋病毒感染率惊人而提交的。疾病预防控制中心最近报告说，在2006年至2009年期间，除了年轻的男男性行为者，美国所有人群的艾滋病毒发病率都保持稳定。年轻的男男性行为者中发病率的总体增加是由年轻的非洲裔美国男男性行为者中艾滋病毒感染增加48%驱动的。这项研究的广泛、长期目标是确定降低艾滋病毒感染率的战略， 年轻的非洲裔美国男男性接触者这项研究将利用男性对移动的电话技术的狂热使用，提供一种创新的干预措施，以改变他们的性风险行为。具体目标是：1）开发一种基于移动的交互式电话的艾滋病毒/性传播感染风险降低干预措施，该干预措施可接受且可行，可在18至24岁的非洲裔美国男男性行为者中实施; 2）开发一种可接受且可行的短信预防策略，旨在提高其效力; 3）与关注艾滋病毒/性传播感染风险的干预措施相比，采取控制干预措施，增加报告在肛交和阴道性交期间始终使用避孕套的男子比例;和4）在随机分配到定制文本的男性中，与对照干预相比，是否增强了艾滋病毒/性传播感染风险降低的功效-与其他男性相比，这是一种积极的干预。年龄在18至24岁之间的非洲裔美国男性，如果在筛选前2个月内报告与男性发生肛交，则有资格参与研究。干预和预防策略将通过一个迭代过程来制定，该过程涉及焦点小组、社区咨询委员会的投入、可用性测试和小规模试点测试。潜在疗效的证据将基于一项涉及180名男性的试点随机对照试验，随访6个月。男性将被随机分配到艾滋病毒/性传播感染风险降低或注意力控制干预。此外，他们将被随机分配接收或不接收干预特定的，个性化定制的短信。该方法借鉴了社会认知理论和申请人对目标人群的初步研究。自我报告的一致使用避孕套，其他性行为，艾滋病毒检测和变量假设调解干预效果将通过音频计算机辅助自我访谈收集。使用移动的电话技术进行干预将减轻参与者对通过参加小组或讲习班干预而暴露其与男子的性关系的担忧。如果目前的智能手机使用趋势继续下去，这项研究有可能产生一个具有成本效益的干预，地方，州或国家组织可能会提供给他们的年轻的非洲裔美国男男性接触者的客户。拟议的研究具有重大的公共卫生意义，因为尽管年轻的非洲裔美国男男性接触者在美国的艾滋病毒感染率最高，但缺乏针对他们的有效艾滋病毒/性传播感染干预措施。 公共卫生相关性：在美国，男男性行为者（MSM）仍然是新增艾滋病毒病例数量最多的人群，非洲裔美国男男性行为者中新诊断的艾滋病毒感染率尤其高，与许多撒哈拉以南非洲国家的艾滋病毒感染率不相上下。 然而，没有发表的随机对照试验已经测试了年轻的非洲裔美国男男性行为者的艾滋病毒/性病风险降低干预措施。这些人都是移动的手机的狂热用户，如果目前的趋势在智能手机的所有权继续下去，这项研究的潜在产品，如果成功的话，可能是一个具有成本效益的干预，地方，州，或国家组织可以提供给他们年轻的非洲裔美国男男性接触者的客户。

DESCRIPTION (provided by applicant): This proposal is submitted in response to the alarming rates of HIV among young African American men who have sex with men (MSM). The CDC recently reported that between 2006 and 2009, HIV incidence was stable among all populations in the US except young MSM. The overall increase in incidence among young MSM was driven by a 48% increase in HIV infections among young African American MSM. The broad, long-term objective of this research is to identify strategies to reduce the rates of HIV in young African American MSM. This research will take advantage of the men's avid use of mobile phone technology to deliver an innovative intervention to change their sexual risk behavior. The Specific Aims are to: 1) develop an interactive mobile phone-based HIV/STI risk-reduction intervention that is acceptable and feasible to be implemented with African American MSM ages 18 to 24 years; 2) develop an acceptable and feasible text-messaging adjunctive strategy designed to increase its efficacy; 3) pilot test the efficacy of the HIV/STI risk-reductio intervention compared with an attention-control intervention in increasing the proportion of men who report consistent condom use during anal and vaginal intercourse; and 4) pilot test whether the efficacy of the HIV/STI risk-reduction compared with the control intervention is enhanced among men randomized to the tailored text-messaging adjunctive intervention as compared with other men. African American men ages 18 to 24 years who report having anal intercourse with a man in the 2 months prior to screening will be eligible to participate. The intervention and adjunctive strategy will be developed using an iterative process involving focus groups, input from a community advisory board, usability testing, and small-scale pilot testing. Evidence of potential efficacy will be based on a pilot randomized controlled trial involving 180 men with 6-month follow-up. Men will be randomly assigned to the HIV/STI risk-reduction or an attention-control intervention. In addition, they will be randomly assigned to receive or not receive intervention-specific, individually tailored text messages. The approach draws on social cognitive theory and the applicant's Preliminary Studies with the target population. Self-reported consistent condom use, other sexual behaviors, HIV testing, and variables hypothesized to mediate intervention efficacy will be collected via audio-computer-assisted self-interviewing. The use of a mobile phone technology for intervention would allay participants' concerns about revealing their sexual involvement with men by virtue of participating in a group or workshop intervention. If current trends in smartphone use continue, this research has the potential to produce a cost-effective intervention that local, state, or national organizations might offer to their young African American MSM clients. The proposed research has great public health significance because although young African American MSM have some of the highest rates of HIV in the US, there is a paucity of efficacious HIV/STI interventions tailored to them. PUBLIC HEALTH RELEVANCE: Men who have sex with men (MSM) continue to account for the largest number of new HIV cases in the US, and the rates of newly diagnosed HIV in young African American MSM are especially high, rivaling those in many sub-Saharan African nations. Yet, no published randomized controlled trial has tested HIV/STI risk-reduction interventions for young African American MSM. These men are avid users of mobile phones, and if current trends in smartphone ownership continue, the potential product of this research, if successful, might be a cost-effective intervention that local, state, or national organizations can offer to thir young African American MSM clients.