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：美国艾滋病病毒的种族和地理差异有所增加，特别是在 黑人女性。农村黑人妇女感染艾滋病毒的风险更大，确诊为晚期，而且不太可能 与其他种族和少数民族妇女相比，维持病毒抑制。黑人女性也有 性传播感染(STI)的比率比其他女性更高；许多STI没有症状， 没有确诊，也没有得到治疗。性传播感染会使一个人感染艾滋病毒的风险增加两倍。有证据表明， 居住在农村社区是艾滋病毒筛查率较低的风险因素，增加了围绕 艾滋病毒诊断，较晚的艾滋病毒诊断，较晚采用抗逆转录病毒治疗，因此导致艾滋病毒- 相关死亡率，突出检测障碍、与护理的联系以及与暴露前预防的联系 (准备)。家庭艾滋病毒/性传播感染检测有望通过绕过障碍提高检测率，从而 通过早期发现和护理降低医疗成本。家庭艾滋病毒/性传播感染检测也是将 黑人妇女感染艾滋病毒的风险很高，可以进行预防接种。然而，仅靠家庭测试可能无法克服所有障碍。配对 通过旨在增加动力和克服障碍的干预措施进行家庭测试最有希望 以提高艾滋病毒/性传播感染的检测率。建议增补批出的R34(1R34MH128054-01)的目的是 重点关注生活在农村地区的黑人妇女，开展形成性研究(目标1)，这对于 干预发展(目标2)。干预利用了3个组成部分，即情境、信息- 动机-行为(SIMB)模型、心理对比和实施意图，以开发新的网络- 以干预为基础。这项干预包括5个环节：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。每个人 会议的结构是一样的：关于每种行为的重要性的信息，通过精神激励 对比和克服识别出的障碍的方法，以及提高自我效能的行为技能。这个 补充将分两个阶段进行，这两个阶段与开发和文化定制干预的目标相吻合。1) 进行形成性研究，为基于网络的艾滋病毒家庭检测干预措施的发展提供信息 生活在农村地区的黑人妇女感染艾滋病毒的风险很高。我们建议对20名布莱克进行深入采访 生活在德克萨斯州中部农村地区的妇女探索SIMB的结构，心理对比， 和实施意向，以开发将在目标2中进行现场测试的干预方案)开发和 为居住在中环农村地区的黑人妇女量身定做基于网络的艾滋病毒家庭检测干预措施 德克萨斯州。我们将开发基于网络的干预措施，并在10名黑人妇女中进行现场测试 在农村地区。基于网络的干预设计大大增加了实施的机会 大规模地。长期目标是通过以下途径增加农村地区黑人妇女的艾滋病毒/性传播感染检测 可扩展和可持续的方法，以减少艾滋病毒传播和随后的差异。

Project Summary: Racial and geographic disparities in HIV have increased in the US, particularly among Black women. Rural Black women are at greater risk of HIV infection, late-stage diagnosis, and are less likely to sustain viral suppression compared to other racial and ethnic minority women. 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. Evidence indicates that living in a rural community is a risk factor for lower rates of HIV screening, increased stigma surrounding an HIV diagnosis, later HIV diagnoses, late adoption of antiretroviral therapy, therefore leading to increase HIV- related mortality, highlighting barriers to testing, linkage to care, and linkage to pre-exposure prophylaxis (PrEP). 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 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 supplement to the awarded R34 (1R34MH128054-01) aims to focus on Black women living in rural areas and conduct formative research (aim 1) that is imperative for intervention development (aim 2). The intervention 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, motivation via mental contrasting and methods to overcome the identified barriers, and behavioral skills to increase self-efficacy. The supplement will occur in 2 phases that coincide with the aims to develop and culturally tailor the intervention. 1) Conduct formative research to inform the development of the web-based HIV home testing intervention for Black women at high risk for HIV living in rural areas. We propose to conduct in-depth interviews with 20 Black women living in rural geographic areas in Central Texas to explore the constructs of sIMB, mental contrasting, and implementation intentions to develop the intervention protocol to be field tested in aim 2. 2) develop and tailor the web-based HIV home testing intervention for Black women living in rural geographic areas in Central Texas. We will develop the web-based intervention and field test the intervention among 10 Black women living in rural areas. 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 Black women in rural areas via scalable and sustainable methods to decrease HIV transmission and subsequent disparities.