Building mobile HIV prevention and mental health support in low-resource settings

项目摘要 该项目旨在弥补未解决且相互关联的艾滋病毒预防和心理健康需求。 在中东欧国家罗马尼亚的同性恋和双性恋男性(GBM)中，他们的 支持与污名相关的机制。猖獗的耻辱加剧了艾滋病毒的流行 在罗马尼亚的GBM中(根据最佳估计，从2009年的不到10%上升到2014年的近20%)和 使GBM无法获得艾滋病毒预防服务。我们的mHealth试点干预(标题为“Deprere地雷。 德普雷·诺伊。“[DMDN]翻译为“关于我。关于我们。)，这降低了美国和罗马尼亚GBM HIV感染在最初的前期试验中也减少了抑郁和酗酒，现在已经准备好进行测试 在一项包含大量全国样本的随机对照试验中。DMDN干预需要8个60分钟 由训练有素的咨询师在我们的移动学习平台上使用激励性访谈进行实时聊天 认知-行为技能培训(CBST)。第一，在预审期间(MOS 1-5)，与 由GBM社区成员组成的社区咨询委员会，GBM-肯定的身体和精神 医疗服务提供者和我们的技术开发人员，我们将根据我们的试点对DMDN干预进行微调 调查结果和评估访谈，并为教育扩展原始DMDN教育材料 注意状态(EAC)，将作为我们的控制。第二，在干预阶段(MOS 6-45)，我们 将招募、筛选、评估有艾滋病毒感染和酗酒风险的GBM到DMDN 干预组(n=163)或急诊组(n=163)。两个条件都是内容匹配的，都是在我们的研究上托管的 站台。DMDN将包括每周八个mHealth实时聊天会话，而eAC将包括八个自我聊天会话 管理的教育模块。第三，在后续阶段(MOS8-55)，我们将在4、8和12进行评估 基线后几个月，以与基线相同的移动方式，无套管肛门的主要结果 与男性伴侣的性行为和酗酒、抑郁、生物艾滋病毒/性传播感染的继发性后果， 艾滋病毒/性传播感染检测和植根于信息-动机-行为技能(IMB)的心理社会机制 模型(如艾滋病毒/性传播感染知识、使用避孕套的自我效能)和少数群体压力理论(如认同感 隐藏，内在化的同性恋恐惧症)。我们假设1)与随机分配给EAC的GBM相比，那些 随机到mHealth DMDN的情况将报告无套肛交的显著减少 12个月的随访，2)IMB和少数民族应激机制将在统计上中介干预效果， 3)与EAC相比，DMDN干预在避免艾滋病毒感染方面将被证明具有成本效益 减少抑郁和酗酒。如果有效且性价比高，DMDN将呈现高度的 可传播的干预措施，可显著预防高耻辱感、低羞耻感和低风险人群中的HIV感染 资源区，那里的GBM受到艾滋病毒的影响不成比例，但实体却遥不可及 预防服务。

Project Summary This project is designed to remedy unaddressed and interlocking HIV-prevention and mental health needs among gay and bisexual men (GBM) in the Central Eastern European country of Romania, and their underpinning stigma-related mechanisms. Rampant stigma contributes to the increasing prevalence of HIV among Romanian GBM (from under 10% in 2009 to close to 20% in 2014, by best available estimates) and keeps GBM out-of-reach of HIV-prevention services. Our mHealth pilot intervention (titled “Despre Mine. Despre Noi.” [DMDN] translated as “About Me. About Us.”), which reduced US and Romanian GBM’s risk for HIV infection while also reducing depression and alcohol abuse in initial pre-post trials, is now ready for testing in a randomized controlled trial with a large national sample. The DMDN intervention entails eight 60-minute live chat sessions delivered by trained counselors on our mobile study platform using motivational interviewing (MI) and cognitive-behavioral skills training (CBST). First, during pre-trial (mos 1-5), in collaboration with a community advisory board consisting of GBM community members, GBM-affirmative physical and mental health providers, and our technical developer, we will fine-tune the DMDN intervention based on our pilot findings and evaluation interviews, and expand the original DMDN education materials for an education attention condition (EAC) that will serve as our control. Second, during the intervention phase (mos 6-45), we will recruit, screen, assess, and randomize GBM at risk for HIV infection and alcohol abuse to either the DMDN intervention (n=163) or EAC (n=163). The conditions are content matched, and both are hosted on our study platform. While DMDN will consist of eight weekly mHealth live chat sessions, EAC will consist of eight self- administered educational modules. Third, during the follow-up phase (mos 8-55), we will assess at 4, 8, and 12 months post-baseline, in a mobile fashion identical to the baseline, the primary outcome of condomless anal sex with male partners and secondary outcomes of alcohol abuse, depression, biologic HIV/STI infection, HIV/STI testing, and psychosocial mechanisms rooted in the Information-Motivation-Behavioral Skills (IMB) model (e.g., HIV/STI knowledge, condom use self-efficacy) and minority stress theory (e.g., identity concealment, internalized homophobia). We hypothesize that 1) compared to GBM randomized to EAC, those randomized to the mHealth DMDN condition will report significant reductions in condomless anal sex across the 12-month follow-up, 2) IMB and minority stress mechanisms will statistically mediate intervention efficacy, and 3) compared to EAC, the DMDN intervention will prove cost-effective in terms of HIV infections averted and reduced depression and alcohol abuse. If efficacious and cost-effective, DMDN presents a highly disseminable intervention that could significantly prevent HIV infection among GBM in high-stigma, low- resource areas, where GBM are disproportionately affected by HIV, yet kept out-of-reach of brick-and-mortar prevention services.