Brief, web-based intervention to reduce heavy drinking and encourage prevention among high-risk men completing HIV/STI self-testing

项目总结/摘要 在美国，男男性行为者的新艾滋病毒感染率保持稳定 (MSM)近年来，尽管大多数其他高危群体的死亡率有所下降，但这突出表明， 创新的方法来预防男男性接触。饮酒是男男性行为者感染艾滋病毒的主要危险因素， 部分原因是酗酒倾向于增加可能传播艾滋病毒的性行为的可能性。 我们的工作还表明，酗酒者在CDC推荐范围内进行艾滋病毒检测的可能性较小 的间隔这种程度的饮酒在男男性行为者中很常见，高达40%的人报告过去曾大量饮酒 月在家中进行艾滋病毒和性传播感染自我检测是鼓励定期检测的一项有希望的战略。定期 检测可以帮助更早发现更多新感染，防止进一步感染并提高死亡率。 尽管自我检测的承诺，很少有人知道最好的方式提供支持，同时艾滋病毒/性传播感染自我检测， 测试程序。虽然目前许多自我测试程序提供收件人访问24小时 尽管他们可以打电话寻求咨询和转介，但很少有人使用这项服务。提供的咨询也很少 这是一个理论性的问题，往往没有解决维持风险的关键因素，如饮酒。基于网络， 简短的干预可能是一种非常适合在这些计划的同时提供支持的方法， 可以帮助男男性接触者参与这些项目，以减少他们的酒精使用和开始使用艾滋病毒预防 有效的方法。在以前的支持下，我们开发了游戏计划，一个互动的，响应式的网站 应用基于证据的简短动机干预后建模。它旨在帮助高风险， 大量饮酒的男男性接触者在接受检测时，会考虑减少他们的酗酒和性风险行为。 艾滋病。在一项对40名酗酒、高危男男性接触者的初步研究中， 报告说，酗酒天数减少了24%，酒精问题减少了17%，新的肛交伴侣减少了50%， 在三个月的随访期内，与对照组相比，高风险无安全套性行为（CAS）减少了12%。 拟议的研究涉及进行一项更大规模的研究，探讨游戏计划在男男性行为者中的影响， 现实世界，以及扩大艾滋病毒检测的创新方法。使用混合1效能- 实施办法中，我们将从网上招募360名高危、重度饮酒的男男性行为高发人群 在美国的地区参加一个计划，提供以家庭为基础的艾滋病毒/性传播感染自我测试，在邮件定期 间隔一年（基线、6个月、12个月）。参与者将被随机分配， （1）24小时咨询/转介热线，或（2）咨询热线加游戏计划。我们将测试 那些使用游戏计划的人显示出较低的酗酒率，任何性传播感染，和高风险的CAS事件相比， 只有那些能接触到毒品的人混合方法也将用于游戏计划 用户（N=30）和测试推广项目利益相关者（N=12）开始了解关键实施 这些结果可以指导我们设计将游戏计划实施到艾滋病毒/性传播感染检测项目中的战略。

Project Summary/Abstract In the United States, rates of new HIV infections have remained stable among men who have sex with men (MSM) in recent years despite declines among most other at-risk groups, highlighting the continued need for innovative approaches to prevention for MSM. Alcohol use is a major risk factor for HIV infection among MSM, in part due to the tendency for heavy drinking to increase the odds of engaging in sex that can transmit HIV. Our work has also shown that heavy drinkers are less likely to have tested for HIV within CDC-recommended intervals. This level of drinking is common among MSM, with up to 40% reporting heavy drinking in the past month. Home-based HIV and STI self-testing is a promising strategy for encouraging regular testing. Regular testing can help detect more new infections earlier, preventing onward infections and improving mortality. Despite self-testing’s promise, little is known about the best ways to provide support alongside HIV/STI self- testing programs. Although many current self-testing programs provide recipients with access to a 24-hour helpline they can call for counseling and referrals, few use this service. The counseling provided is also rarely informed by theory and often does not address key factors that maintain risk, like alcohol use. Web-based, brief interventions may be one approach that is well-suited to provide support alongside these programs and could help MSM participating in these programs to reduce their alcohol use and begin using HIV prevention methods that work. With previous support, we developed Game Plan, an interactive, responsive web application modeled after evidence-based brief motivational interventions. It is designed to help high-risk, heavy drinking MSM consider reducing their binge drinking and sexual risk behavior when they get tested for HIV. In a preliminary study of 40 heavy drinking, high-risk MSM, those who used Game Plan after HIV testing reported 24% fewer binge drinking days, 17% fewer alcohol problems, 50% fewer new anal sex partners, and 12% fewer high-risk condomless sex (CAS) acts compared to controls over a three-month follow-up period. The proposed study involves conducting a larger-scale study exploring Game Plan’s effects among MSM in the real-world, alongside innovative approaches for expanding HIV testing. Using a hybrid 1 effectiveness- implementation approach, we will recruit 360 high-risk, heavy drinking MSM online from several high-incidence areas in the US to participate in a program providing home-based HIV/STI self-tests in the mail at regular intervals over a year (baseline, 6 months, 12 months). Participants will be randomly assigned to receive access to either (1) a 24-hour helpline for counseling/referrals, or (2) the helpline plus Game Plan. We will test whether those who use Game Plan show lower rates of heavy drinking, any STIs, and high-risk CAS events compared to those receiving access to the helpline alone. Mixed-methods approaches will also be used with Game Plan users (N=30) and testing outreach program stakeholders (N=12) to begin understanding key implementation outcomes that can guide us in designing strategies for implementing Game Plan into HIV/STI testing programs.