Exploring Syndemic Factors associated with HIV and STI Testing Preferences Among Students at an HBCU in Alabama

项目总结 黑人青少年和年轻人(AYA)受艾滋病毒流行的影响不成比例。在阿拉巴马州 (Al)，在美国结束艾滋病毒流行(EHE)倡议中被确定为地理热点的州， 30%的新艾滋病毒感染发生在13至24岁的人群中，其中80%以上的感染发生在黑人 阿亚斯。除了艾滋病毒在这一人群中的高发病率外，性传播感染(STI)的比率 南方的人口比例也很高，黑人AYA受到的影响不成比例。考虑到基本上没有症状的性质 对于艾滋病毒和性传播感染，检测对于诊断是必要的；然而，只有9%的青少年接受过检测 这一人群的艾滋病毒和每年的性传播感染检测率约为9%。运用共性理论方法 需要考虑到这一人群中共存的其他流行病，如精神疾病、毒品 使用情况、健康的社会决定因素(SDH)以及它们如何协同增加艾滋病毒和性传播感染 收购风险。为了改善EHE优先领域的艾滋病毒诊断，我们建议评估各种艾滋病毒和性传播感染 测试模式(即，基于设施的测试与家庭测试)。我们将评估可行性、可接受性和 在历史悠久的黑人学院和大学(HBCU)测试学生群体的形态偏好， 斯蒂尔曼学院，位于亚利桑那州塔斯卡卢萨。将利用RE-AIM和CFIR实施科学框架 除了语汇理论框架之外，还可以更好地理解语汇在测试通道中的作用 喜好和坚持到底。在目标1中，我们将从五个现场收集过程数据，艾滋病毒和性传播感染检测 提供者和我们的社区合作伙伴，以评估各种STI和HIV检测的吸收、分发和使用 医疗模式。Five Spot将在收集数据的同时为Stillman的学生提供艾滋病毒和性传播感染检测选项 关于检测吸收和后续护理(例如，接受检测的学生人数、使用的性传播感染和艾滋病毒检测方式、人数 任何性传播感染和/或艾滋病毒检测呈阳性的学生、检测和/或治疗/与护理或预防的联系)。在……里面 目标2，我们将使用定量的在线调查，对135名斯蒂尔曼学院的学生进行评估 对性传播感染和艾滋病毒检测方式的偏好(即，基于设施的检测与家庭检测、二次分发 性危险行为、性传播感染和艾滋病毒检测历史、既往病史、实施结果 受RE-AIM以及可能影响测试吸收和测试偏好的共性因素的影响，例如 精神疾病、药物使用和SDH。在目标3中，我们将对Key进行定性的深度采访 参加斯蒂尔曼学院的利益相关者和学生，探索理解和/或遵循的障碍和促进者 通过艾滋病毒/性传播感染检测和治疗，并确定其他需要的服务。利益相关者面谈将 关注可持续性、扩张机会和未得到满足的需求。我们将征求我们的反馈意见 由主要利益攸关方组成的社区咨询委员会，包括AYA、青年倡导者、医疗保健 在整个学习期间，工作人员和学校行政人员向我们的项目提供信息，并使其适应 阿勒颇的当地社区。

PROJECT SUMMARY Black adolescents and young adults (AYAs) are disproportionately affected by the HIV epidemic. In Alabama (AL), a state identified in the Ending the HIV Epidemic (EHE) initiative for America as a geographic hot spot, over 30% of new HIV infections occur in people aged 13 to 24 with over 80% of these infections occurring in Black AYAs. In addition to high HIV incidence rates among this population, sexually transmitted infection (STI) rates are also high in the South with Black AYAs disproportionately impacted. Given the largely asymptomatic nature of both HIV and STIs, testing is necessary for diagnoses; however only 9% of adolescents have ever been tested for HIV and yearly STI testing rates for this population are around 9%. Utilizing a syndemic theory approach requires the consideration of other co-existing epidemics among this population, such as mental illness, drug usage, and the social determinants of health (SDH) and how they may synergistically increase HIV and STI acquisition risk. To improve HIV diagnosis in an EHE priority area we propose to evaluate various HIV and STI testing modalities (i.e., facility based versus at home testing). We will assess the feasibility, acceptability, and testing modality preferences for student populations at a Historically Black College and University (HBCU), Stillman College, in Tuscaloosa, AL. The RE-AIM and CFIR implementation science frameworks will be utilized in addition to a syndemics theory framework to better understand the role of syndemics in testing modality preferences and follow through. In Aim 1, we will collect process data from Five Spot, the HIV and STI testing provider and our community partner, to evaluate the uptake, distribution, and use of various STI and HIV testing modalities. Five Spot will offer HIV and STI testing options to students attending Stillman while collecting data on testing uptake and follow-up care (e.g., number of students tested, STI and HIV testing modality used, number of students testing positive for any STI and/or HIV, testing and/or treatment/linkage to care or prevention). In Aim 2, we will use a quantitative, online survey with 135 students attending Stillman College to assess preferences for STI and HIV testing modalities (i.e., facility-based versus at home testing, secondary distribution to partners), sexual risk behaviors, STI and HIV testing history, past medical history, implementation outcomes informed by RE-AIM, and syndemic factors that may impact testing uptake and testing preferences, such as mental illness, drug usage, and SDH. In Aim 3, we will conduct qualitative in-depth interviews with key stakeholders and students attending Stillman College to explore barriers and facilitators to uptake and/or follow through of HIV/STI testing and treatment and identify additional needed services. The stakeholder interviews will focus on sustainability, opportunities for expansion, and unmet needs. We will solicit feedback from our Community Advisory Board comprised of key stakeholders including AYAs, youth advocates, healthcare workers, and school administration throughout the study period to inform and adapt our project to the needs of the local community in AL.