Increasing HIV/STI Home Testing, Linkage to Care, and Linkage to PrEP via a Digital Intervention among Black Women in a Geographic Hotspot

项目摘要：在得克萨斯州特拉维斯县，由于艾滋病毒感染率高，被认为是艾滋病毒地理热点， 黑人妇女感染艾滋病毒的可能性是其他种族/民族妇女的18.4倍。黑色 女性的性传播感染(STI)率也比其他女性高；许多STI没有 症状，没有诊断，也没有治疗。性传播感染会使一个人感染艾滋病毒的风险增加两倍。在特拉维斯 在该县，超过20%的妇女在感染艾滋病毒一年后得知自己是艾滋病毒阳性，强调 测试的障碍。家庭艾滋病毒/性传播感染检测有望通过绕过障碍和 从而通过早期发现和护理来降低医疗成本。家庭艾滋病毒/性传播感染检测也是一个主要的 将感染艾滋病毒的高危黑人妇女与暴露前预防(PrEP)联系起来的机会。然而，家庭测试 单枪匹马可能无法克服所有障碍。将家庭测试与旨在增加动力的干预措施相结合 克服障碍最有希望提高艾滋病毒/性传播感染检测率。拟议的项目借鉴了 三个组成部分，情境，信息-动机-行为(SIMB)模型，心理对比，以及 实施意向，以开发一种新的、基于网络的干预措施。这一干预措施包括5项 会议：1)使用HIV/STI家庭检测试剂盒，2)邮寄试剂盒，3)检查结果，4)获得治疗， 5)参加PrEP的预约。每个会话的结构都相同：有关 每种行为的重要性(即，参加家庭测试、邮寄测试、检查结果、与护理的联系、 和与PrEP的联系)，通过心理对比来激励(确定积极的结果和每个结果的障碍 会议)和克服已确定障碍的方法(实施意图)，以及以下行为技能 提高自我效能感。该项目将分三个阶段进行，与发展和文化目标相吻合 量身定制干预措施。1)开展形成性研究，开展干预。四个焦点小组(n=4-6)， 来自特拉维斯县的24名黑人女性将探索SIMB的结构，心理对比，以及 实施意向，以制定将在AIM 2中进行现场测试的干预方案。2)现场测试 干预。我们将与6名参与者一起测试干预的初步可行性和可接受性 对目标3进行任何必要的调整。3)进行干预的可行性试验。我们将决定 特拉维斯县60名黑人妇女的可行性、可接受性和初步疗效。参与者将 被随机分配到干预或基于网络的教育控制。我们假设 干预将是可行的、可接受的，并显示出完成家庭的有效性的趋势 测试、与护理的关联以及与PrEP的关联。后续基于网络的评估将管理2-，4-， 基线后6个月。基于网络的干预设计极大地增加了 大规模实施。长期目标是在低收入黑人中增加艾滋病毒/性传播感染检测 通过可扩展和可持续的方法减少艾滋病毒传播和随后的差异。

PROJECT SUMMARY: In Travis County, Texas, deemed a HIV geographic hotspot due to high HIV rates, Black women are 18.4 times more likely to contract HIV compared to women of other races/ethnicities. Black women also have higher rates of sexually transmitted infections (STIs) than other women; many STIs have no symptoms, are undiagnosed, and are untreated. Having an STI triples one's risk for contracting HIV. In Travis County, over 20% of women learned one year after contracting HIV that they were HIV-positive, highlighting barriers to testing. Home HIV/STI testing has promise to increase rates of testing by circumventing barriers and thereby reduce medical costs through early detection and care. Home HIV/STI testing is also a prime opportunity to link Black women at high risk for HIV to pre-exposure prophylaxis (PrEP). Yet, home testing alone may not overcome all barriers. Pairing home testing with an intervention designed to increase motivation and overcome barriers has the most promise to increase HIV/STI testing rates. The proposed project draws on 3 components, the situated, information-motivation-behavioral (sIMB) model, mental contrasting, and implementation intentions to develop a new, web-based intervention. This intervention is comprised of 5 sessions: 1) using the HIV/STI home testing kit, 2) mailing in the kit, 3) checking results, 4) obtaining treatment, and 5) attending an appointment for PrEP. Each session is structured the same: information regarding the importance of each behavior (i.e., taking the home test, mailing in the test, checking results, linkage to care, and linkage to PrEP), motivation via mental contrasting (identifying positive outcomes and barriers to each session) and methods to overcome the identified barriers (implementation intentions), and behavioral skills to increase self-efficacy. The project will occur in 3 phases that coincide with the aims to develop and culturally tailor the intervention. 1) Conduct formative research to develop the intervention. Four focus groups (n=4-6), with 24 Black women from Travis County will explore the constructs of sIMB, mental contrasting, and implementation intentions to develop the intervention protocol to be field tested in Aim 2. 2) Field test the intervention. We will test the preliminary feasibility and acceptability of the intervention with 6 participants to make any necessary adjustments for Aim 3. 3) Conduct a feasibility pilot of the intervention. We will determine the feasibility, acceptability, and preliminary efficacy among 60 Black women in Travis County. Participants will be randomly assigned to the intervention or a web-based educational control. We hypothesize that the intervention will be feasible, acceptable, and demonstrate a trend toward efficacy for completion of home testing, linkage to care, and linkage to PrEP. Follow-up web-based assessments will be administered 2-, 4-, and 6-months after baseline. The web-based design of the intervention greatly increases the opportunity for implementation on a large scale. The long-term goal is to increase HIV/STI testing among low-income Black women via scalable and sustainable methods to decrease HIV transmission and subsequent disparities.