Peer-driven Intervention to Seek, Test & Treat Heterosexuals at High Risk for HIV

描述（由申请人提供）：在美国，大约21%的艾滋病毒感染未被诊断，但只有大约40%的成年人接受了检测。因此，艾滋病毒的晚诊断很常见，此外，治疗延误和中断也很普遍。高风险异性恋者（HHR）检测艾滋病毒的可能性显著降低，更有可能在晚期被诊断出患有艾滋病毒，并且与其他群体相比，在进入护理方面遇到严重障碍。我们的研究小组研究了纽约市（NYC）的HHR，作为CDC国家艾滋病行为监测（NHBS）研究的一部分。我们发现纽约市HHR的艾滋病毒感染率为7.4%，其中只有6%的感染者以前被诊断过。此外，在布鲁克林中部，10%的人被新诊断出感染艾滋病毒。拟议的研究将使用NHBS方法来针对HHR。HHR中艾滋病毒检测和治疗率的降低是由于结构性原因（例如，访问困难），社会（例如，同伴规范），和个人水平（例如，低感知风险）的障碍。因此，需要以NHBS为模型的积极招募方法来克服结构性障碍，同行提供的干预措施有效地减少了检测和治疗的个人和社会障碍。拟议研究的主要目标是评估多水平增强型同伴驱动干预（PDI）的有效性，以寻求、测试、治疗和保留HHR。增强的PDI是专门为HHR量身定制的，包括计算机化，导航和同行交付的组件，以提高未来的可持续性。干预的设计以三元影响理论和规范调节理论为指导。与NHBS类似，增强的PDI将使用响应驱动采样（RDS）。NHBS协议使用基于场地的采样（VBS）和RDS来接触高危人群。然而，VBS和RDS尚未在未确诊的艾滋病毒感染率方面进行直接比较。因此，这项为期五年的研究的具体目标是：（1）比较RDS和VBS的产量和效率，以确定HHR中未确诊的HIV感染;（2）测量增强的PDI与对照组相比，在HIV护理和HAART启动时间、病毒载量抑制和新诊断患者的保留方面的疗效;（3）检查PDI对HIV健康/治疗结果的影响是否由个体的变化介导（例如，感知风险），社会（例如，同伴规范），和结构影响（例如，增强接入），和/或是否有其它因素（例如，物质使用）缓和其影响;（4）预测RDS与VBS和PDI的成本和成本效益。我们将在布鲁克林市中心进行增强的PDI（N=3000），这是一个艾滋病毒高流行的地方，HHR在那里很难获得检测和治疗。同时，VBS（N=400）将在布鲁克林中心进行。拟议的研究补充了地方和国家艾滋病毒预防举措，旨在为艾滋病毒预防组合提供有效，创新和可持续的多层次招聘方法和干预措施。绝大多数HHR是非洲裔美国人或拉丁美洲人;因此，拟议的研究也可能影响艾滋病毒/艾滋病的种族/民族差异。

DESCRIPTION (provided by applicant): Approximately 21% of HIV infections in the U.S. are undiagnosed, but only about 40% of all adults have been tested. Thus, late diagnosis of HIV is common, and, furthermore, treatment delays and disruptions are widespread. Heterosexuals at high risk (HHR) are significantly less likely to test for HIV, are more likely to be diagnosed with HIV late, and experience serious barriers to entering care compared to other groups. Our research team has studied HHR in New York City (NYC) as part of the CDC's National HIV Behavioral Surveillance (NHBS) studies. We found an HIV prevalence rate of 7.4% among HHR in NYC, and only 6% of these infections had been previously diagnosed. Further, in central Brooklyn, 10% were newly diagnosed with HIV. The proposed study will use NHBS methodology to target HHR. Reduced rates of HIV testing and treatment among HHR are due to structural (e.g., poor access), social (e.g., peer norms), and individual-level (e.g., low perceived risk) barriers. Thus active recruitment approaches modeled after NHBS are needed to overcome structural barriers, and peer-delivered interventions effectively reduce individual and social barriers to testing and treatment. The primary goal of the proposed study is to evaluate the efficacy of a multi-level enhanced peer-driven intervention (PDI) to seek, test, treat and retain HHR. The enhanced PDI is tailored specifically for HHR and includes computerized, navigation, and peer-delivered components to enhance future sustainability. The design of the intervention is guided by the Theories of Triadic Influence and Normative Regulation. Similar to NHBS, the enhanced PDI will use respondent-driven sampling (RDS). NHBS protocols use both venue-based sampling (VBS) and RDS for reaching populations at high risk. However, VBS and RDS have not yet been directly compared in terms of their yield of undiagnosed HIV infections. Thus the specific aims of this five-year proposed study are to: (1) compare the yield and efficiency of RDS and VBS to identify undiagnosed HIV infection among HHR; (2) measure the efficacy of an enhanced PDI compared to a control in terms of time to HIV care and HAART initiation, viral load suppression, and retention among those newly diagnosed; (3) examine whether the effects of the PDI on HIV health/treatment outcomes are mediated by changes in individual (e.g., perceived risk), social (e.g., peer norms), and structural influences (e.g., enhanced access), and/or whether other factors (e.g., substance use) moderate its effects; and (4) to project the costs and cost-effectiveness of RDS vs. VBS and PDI. We will conduct the enhanced PDI (N=3000) in central Brooklyn, a location hyperendemic for HIV and where HHR experience poor access to testing and treatment. Simultaneously, VBS (N=400) will be undertaken in central Brooklyn. The proposed study complements local and national HIV prevention initiatives and is designed to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. The vast majority of HHR are African-American or Latino; therefore the proposed study may also impact racial/ethnic disparities in HIV/AIDS.