A Pragmatic Trial of An Adaptive eHealth HIV Prevention Program for Diverse Adolescent MSM

项目摘要 青少年(13-18岁)男男性行为者(AMSM)经历了巨大的健康差距 因为他们占年轻人的2%，但几乎占艾滋病毒诊断的80%。尽管如此 负担不成比例，明显缺乏以证据为基础的艾滋病毒预防计划。 实施问题至关重要，因为传统的艾滋病毒预防提供渠道(社区组织、 学校，家长)，当谈到AMSM时，有很大的限制。电子健康干预代表着一种 在年轻人“所在”的地方提供针对AMSM的干预材料的极佳方式。 当参与者没有回应时，我们不应该继续提供同样的干预。更确切地说， 阶梯式护理策略增加了强度，以满足那些没有对不那么强烈的反应的人的需求 干预。使用序贯多任务随机试验(SMART)设计，我们将评估 一系列日益密集的干预措施的影响，这些干预措施已经显示出对 不同的青少年和年轻成年男男性接触者。智能设计是实现这一目标的理想途径 RFA，因为智能设计模仿了现实世界临床中做出的治疗决策 设置。总体而言，我们将我们的电子健康干预方案命名为SMART计划(性少数 青少年冒险)。该一揽子计划包括：(1)普遍提供的、简短的网上性健康 为性和性别少数族裔青年设计的教育方案，无论他们是否有性行为 积极(同性恋性教育)；(2)针对参与艾滋病毒的不同AMSM设计的更密集的在线干预 传播风险行为(保持下去！)和(3)最密集的是激励性面试(MI) 干预措施将由心肌梗塞治疗师通过在线视频网站(青年男性健康项目)提供。我们会 评估SMART计划的影响，并为未来的实施提供三个具体目标。 目标1是测试SMART计划及其组成部分在降低艾滋病毒风险和 加大检测力度。我们将使用Adapt-ITT开发适用于AMSM的现有内容 框架和语言上使SMART计划适应西班牙语拉丁裔AMSM。我们将招收一个 对1,878种不同的AMSM进行全国抽样，并使用智能设计测试该计划的有效性。 目标2是测试SMART计划是否在AMSM的重要子组中具有不同的疗效 基于种族/民族、城市/农村、年龄、社会经济地位和语言。 目标3是在全国范围内评估SMART计划的交付情况，以便为其实施和 成本效益。为了最大限度地减少科学与实践的差距，我们将使用混合方法来确定促进者 以及通过收集措施实施SMART方案及其核心组成部分的障碍 来自RE-AIM框架并执行成本分析。

Project Summary Adolescent (ages 13-18) men who have sex with men (AMSM) experience a dramatic health disparity as they represent 2% of young people but account for almost 80% of HIV diagnoses. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (community organizations, schools, parents), have significant limitations when it comes to AMSM. eHealth interventions represent an excellent modality for delivering AMSM-specific intervention material where youth “are.” We should not continue to deliver the same intervention when a participant is not responding. Rather, stepped-care strategies increase in intensity to meet the needs of those who do not respond to a less intense intervention. Using a Sequential Multiple Assignment Randomized Trial (SMART) design, we will evaluate the impact of a package of increasingly intensive interventions that have already shown evidence of efficacy with diverse adolescent and young adult MSM. The SMART design is an ideal approach to achieve the goals of this RFA because SMART designs mimic treatment decisions as they are made in real-world clinical settings. Collectively we brand our package of eHealth interventions as the SMART Program (Sexual Minority Adolescent Risk Taking). The Program package includes: (1) a universally-delivered, brief, online sexual health education program designed for sexual and gender minority youth regardless of whether they are sexually active (Queer Sex Ed); (2) a more intensive online intervention designed for diverse AMSM engaging in HIV transmission risk behaviors (Keep It Up!), and (3) the most intensive is a motivational interviewing (MI) intervention that will be delivered by MI therapists via online videochat (Young Men's Health Project). We will evaluate SMART Program impact and inform future implementation with three specific aims. Aim 1 is to test impact of the SMART Program and its constituent components on reducing HIV risk and increasing testing among. We will developmentally adapt existing content for AMSM using the ADAPT-ITT framework and linguistically adapt the SMART Program to Spanish speaking Latino AMSM. We will enroll a national sample of 1,878 diverse AMSM and test the efficacy of the Program using a SMART design. Aim 2 is to test if the SMART Program has differential efficacy across important sub-groups of AMSM based on race/ethnicity, urban/rural, age, socioeconomic status, and language. Aim 3 is to evaluate the delivery of the SMART Program nationally to inform its implementation and cost-effectiveness. To minimize the science-practice gap, we will utilize mixed methods to identify facilitators and barriers to the implementation of the SMART Program and its core components by collecting measures from the RE-AIM framework and performing cost analysis.