Novel Stigma/Structural Interventions for Increasing HIV/STI Testing Among BMSM

该申请要求支持开展结构性和以污名为重点的干预措施，以增加艾滋病毒和性传播感染的发生率。 测试与男性发生性关系的黑人男性（BMSM）。我们的研究计划就是集中在这方面的 由于BMSM中艾滋病毒/性传播感染率高得惊人，这一群体经历了高风险的艾滋病毒/性传播感染。 自美国疫情开始以来的艾滋病发病率和流行率，以及目前的估计 研究表明，尽管BMSM仅占人口的0.2%，但他们占新艾滋病毒感染者的22%。 在我们自己的工作中，我们记录了BMSM中5.1%的年度艾滋病毒发病率和35%的艾滋病毒流行率。 我们未能在艾滋病毒护理连续体的所有点，包括寻求和测试部分，参与BMSM。 疾病预防控制中心建议，艾滋病毒感染风险很大的个人每隔三到六年进行一次艾滋病毒/性传播感染检测。 几个月;然而，这一目标没有实现，因此，一种新的方法来参与BMSM是 needed.为了解决这些缺点，并根据初步研究，我们提出了一个2 × 2阶乘 旨在评估一个旨在提高BMSM中艾滋病毒/性传播感染检测率的模型。我们将测试 以耻辱为重点的干预措施，因为众所周知，耻辱是艾滋病毒/性传播感染检测的一个障碍，但在 解决这一因素;并且，我们将评估在线提供的艾滋病毒/性传播感染检测咨询（与在家咨询相结合 艾滋病毒/性传播感染检测试剂盒），因为这种检测的提供可能会消除接触需要艾滋病毒/性传播感染的BMSM的关键障碍 相关护理服务。具体目标1：评估在计划的艾滋病毒/性传播感染检测咨询中接受艾滋病毒/性传播感染检测的情况 在12个月的随访期内。500名艾滋病毒呈阴性/状况不明的BMSM，以及 报告过去一年与男性伴侣无安全套肛交，很少进行HIV/STI检测（≤1例HIV/STI 在过去一年测试中）将被随机分配到以下四种情况之一：（a）接受基于CDC的风险降低 咨询和预约办公室艾滋病毒/性传播感染检测咨询，（B）接受艾滋病毒污名强化 干预措施，并安排在办公室艾滋病毒/性传播感染检测咨询预约，（c）接受疾病预防控制中心的风险 减少咨询和安排在线，通过视频电话，艾滋病毒/性传播感染测试咨询预约，或（d） 接受艾滋病毒污名强化干预，并安排在线、视频通话、艾滋病毒/性传播感染检测咨询 约会.具体目标2：评估通过以下方式收集的中介（关键理论污名变量）因素： 在3、6和12个月随访时进行评估。具体目标3：进行经济评估，以确定 基于办公室和基于在线的艾滋病毒/性传播感染测试交付形式的成本， 一个全面的社会视角，包括所有的成本。我们的项目有可能 不仅对接触BMSM的方法，而且对改善艾滋病毒/性传播感染的方法， 测试吸收，这可能会改善BMSM之间的多种健康结果。如果有效，我们的方法， 提高艾滋病毒/性传播感染检测的接受率将可立即传播，并将在资源范围内 有限的环境，如社区组织和卫生部门。

This application requests support to conduct structural and stigma-focused interventions to increase HIV and STI testing uptake among Black men who have sex with men (BMSM). Our research proposal is focused on this population due to the alarmingly high rates of HIV/STI among BMSM– this group has experienced elevated rates of HIV incidence and prevalence since the beginning of the US epidemic, and current estimates demonstrate that although BMSM make up only 0.2% of the population they make up 22% of new HIV infections. In our own work we have documented a 5.1% annual HIV incidence and a 35% HIV prevalence among BMSM. We are failing to engage BMSM at all points of the HIV care continuum including the seek and test components. The CDC recommends that individuals at substantial risk for HIV be tested for HIV/STI every three to six months; however, this goal is not being achieved and, therefore, a new approach to engaging BMSM is needed. To address these shortcomings and based on preliminary studies, we are proposing a 2 x 2 factorial design to evaluate a model that is aimed at increasing HIV/STI testing uptake among BMSM. We will test a stigma-focused intervention as stigma is a known deterrent to HIV/STI testing, yet little has been done to address this factor; and, we will evaluate HIV/STI test counseling delivered online (in conjunction with at-home HIV/STI test kits) as this delivery of testing may remove key barriers to reaching BMSM in need of HIV/STI related care services. Specific Aim 1: Assess HIV/STI testing uptake at scheduled HIV/STI test counseling appointments during the 12 month follow-up period. 500 BMSM who are HIV negative/unknown status, and report condomless anal intercourse with a male partner in past year and infrequent HIV/STI testing (≤1 HIV/STI test in past year) will be randomly assigned to one of four conditions: (a) receive CDC-based risk reduction counseling and scheduled for in-office HIV/STI test counseling appointments, (b) receive HIV stigma-enhanced intervention and scheduled for in-office HIV/STI test counseling appointments, (c) receive CDC-based risk reduction counseling and scheduled for online, via video calling, HIV/STI test counseling appointments, or (d) receive HIV stigma-enhanced intervention and scheduled for online, via video calling, HIV/STI test counseling appointments. Specific Aim 2: Evaluate mediating (key theoretical stigma variables) factors collected via assessments at 3, 6, and 12 month follow-ups. Specific Aim 3: Conduct an economic evaluation to determine the costs of the office-based and online-based HIV/STI test delivery formats from both a community-based payer perspective and a comprehensive societal perspective that includes all costs. Our project has the potential to exert a sustained and powerful impact not only on approaches to engaging BMSM, but to improving HIV/STI testing uptake which will likely improve multiple health outcomes among BMSM. If effective, our approach to improving HIV/STI testing uptake would be available for dissemination immediately and would fit within resource limited settings such as community based organizations and health departments.