Get Connected: Linking YMSM to adequate care through a multilevel, tailored WebApp intervention

15 - 24岁男男性行为者（YMSM）中的艾滋病毒感染人数显著增加 在过去的十年里。青年男同性恋者中艾滋病毒流行的特点是种族和族裔之间的惊人差异。 尽管这一流行病迅速蔓延，但缺乏已被证明有效减少艾滋病毒/艾滋病的干预措施。 艾滋病毒在这一人群中的风险。YMS要成功地参与艾滋病毒预防和护理服务， 它们通过一系列在个体处操作的多级障碍（例如，风险意识，自我效能， 得到测试），系统（例如，成本，医疗不信任，缺乏文化上合格的护理），和结构性（例如， 无家可归、费用、耻辱）水平。我们开发了Get Connected（GC）作为在线简短干预， 采用个人和系统一级的定制技术，以减少与有效预防联系的障碍 护理（例如，艾滋病毒/性传播感染检测，PrEP）为YMSM（15 - 24岁）。GC对ATN RFA的响应是其多层次的 方法承认并解决可能阻碍艾滋病毒/性传播感染检测的个人和结构性因素， YMSM中的PrEP摄取。作为拟议的iTech U19的一部分，我们将测试GC的功效， YMSM成功参与当地适当的艾滋病毒预防和护理。大（n = 400）， YMSM的不同样本，来自三个以青年人艾滋病毒高发病率为特征的地点（休斯顿， 费城和新奥尔良），我们建议进行两组随机对照试验，随访12个月。 主要结果包括（1）HIV/STI危险行为，（2）HIV阴性高危人群重复HIV/STI检测 YMSM，和（3）认识和PrEP服务的吸收。次要结局包括事件的处理 性传播感染与艾滋病毒阳性病例之间的联系和继续护理我们还将研究GC的变化 理论化的变化机制，包括YMSM的（1）自我效能得到测试，（2）感知的好处， 测试的障碍为了解决对成功参与护理的结构性影响，艾滋病毒/性传播感染检测点 在GC中列出的公司将根据YMSM在访问后提供的评级接受季度绩效评估 他们的位置。我们将检查营业点对季度绩效评估的满意度， 在与YMSM合作时，在选择测试GC的三个研究地点之间改善服务交付。 将对这些活动进行成本投入分析，以便为可持续性讨论和 GC的干预。如果被证明有效，Get Connected有可能为各种机制提供重要信息 将YMSM与当地可用的艾滋病毒预防服务联系起来。

The number of HIV infections among men who have sex with men aged 15-24 (YMSM) has grown significantly in the past decade. The HIV epidemic among YMSM is marked by staggering disparities by race and ethnicity. Despite this burgeoning epidemic, there is a dearth of interventions that have proven efficacious for reducing HIV risk among this population. For YMS to successfully engage in HIV prevention and care services requires that they navigate a series of multilevel barriers operating at the individual (e.g., risk awareness, self-efficacy to get tested), systems (e.g., costs, medical mistrust, lack of culturally competent care), and structural (e.g., homelessness, costs, stigma) levels. We developed Get Connected (GC) as an online brief intervention that employs individual and systems-level tailoring technology to reduce barriers to linkage to competent prevention care (e.g., HIV/STI testing, PrEP) for YMSM (ages 15-24). GC is responsive to the ATN RFA as its multilevel approach recognizes and addresses individual and structural factors that may impede HIV/STI testing and PrEP uptake among YMSM. As part of the proposed iTech U19, we will test the efficacy of GC for increasing YMSM's successful engagement in locally appropriate HIV prevention and care. With a large (n=400) and diverse sample of YMSM, drawn from three sites characterized by high HIV incidence among youth (Houston, Philadelphia and New Orleans) we propose of two-arm randomized control trial with 12 months of follow-up. Primary outcomes include (1) HIV/STI risk behaviors, (2) repeat HIV/STI testing among HIV-negative high risk YMSM, and (3) awareness and uptake of PrEP services. Secondary outcomes include treatment of incident STIs and linkage and retention in care among incident HIV+ cases. We will also examine changes in GC's theorized mechanisms of change, including YMSM's (1) self-efficacy to get tested, (2) perceived benefits and barriers to get tested. To address structural influences on successful engagement in care, HIV/STI testing sites listed in GC will receive quarterly performance assessments based on ratings that YMSM provide after visiting their locations. We will examine sites' satisfaction with the quarterly performance assessments and their improvements in service delivery when working with YMSM across the three study sites selected to test GC. These activities will be paralleled by a cost input analysis to inform discussions of sustainability and roll out of the GC intervention. If proven efficacious, Get Connected has the potential to significantly inform mechanisms for linking YMSM to locally available HIV prevention services.