Efficacy of Internet-based HIV prevention

描述（由申请人提供）：男男性行为者（MSM）是美国最大的艾滋病毒传播群体，感染在年轻的男男性行为者（18-24岁）中增加最多，然而，很少有艾滋病毒预防计划已经开发并证明对这一脆弱人群有效。为了解决这些艾滋病毒预防问题，我们与社区组织（CBO）合作，在NIH R34赠款的背景下开发和试点测试，保持它！(KIU!),一个针对不同种族YMSM的在线艾滋病预防计划。阿秋！是基于信息-动机-行为技能（IMB）模式的艾滋病风险行为改变和通知的校长的电子学习。我们的小规模试点随机临床试验（RCT）证明了KIU的可行性和可接受性！干预：我们招募了一个种族多样的YMSM样本;通过3个月的随访达到了极好的保留率（89%）;保持了强有力的干预参与;并且相对于积极的对照组，无保护的肛交显著减少了44%。目前提案的总体目标是推进基于技术的艾滋病毒行为预防的科学知识，并通过为YMSM建立创新的电子健康预防计划的有效性来改善公共卫生。我们将通过三个具体目标来实现这些目标。首先，我们将整合KIU！我们希望将干预措施纳入一个广泛使用的卫生技术平台，以提高其可扩展性、适应性和广泛实施的潜力。其次，我们将测试KIU的功效！ 多中心RCT中的电子健康干预：a）招募种族多样的YMSM（N = 750; > 65%的种族/少数民族），他们在芝加哥和纽约的社区合作伙伴诊所检测HIV阴性; B）将参与者随机分配到KIU！干预或HIV知识控制状况;以及c）在基线和3、6和12个月的随访评估时测量干预结果。主要行为结局将是无保护肛交行为的计数，主要生物医学结局将是STI发病率。第三，我们将探讨如果KIU！干预在YMSM的重要亚组中具有不同的功效，这些亚组基于种族/民族、关系状态（严重关系与偶然关系）和同性恋/双性恋身份。我们的乔！在将电子健康解决方案与艾滋病毒和性传播感染检测联系起来方面，该方法具有创新性，并可作为将可扩展的行为预防纳入其他生物医学预防战略的模式。 公共卫生相关性：男男性行为者（MSM）是美国最大的艾滋病毒传播群体，感染在年轻的男男性行为者（18-24岁）中增加最多，然而，很少有艾滋病毒预防计划已经制定并证明对这一脆弱人群有效。该提案的总体目标是通过为YMSM建立一个创新的、基于互联网的艾滋病毒预防计划的有效性来改善公共卫生。

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) are the largest HIV transmission group in the US and infections are increasing most among young MSM (18-24 years), however, few HIV prevention programs have been developed and proven effective with this vulnerable population. To address these HIV prevention concerns, we collaborated with community-based organizations (CBOs) in the context of an NIH R34 grant to develop and pilot test, Keep It Up! (KIU!), an online HIV prevention program tailored to ethnically diverse YMSM. KIU! is based on the Information-Motivation-Behavior Skills (IMB) model of HIV risk behavior change and informed by principals of E-learning. Our small-scale pilot randomized clinical trial (RCT) demonstrated the feasibility and acceptability of the KIU! intervention: we enrolled an ethnically diverse sample of YMSM; achieved excellent retention through 3-month follow-up (89%); maintained robust intervention engagement; and produced a significant 44% decrease in unprotected anal sex relative to an active control. The overarching goal of the current proposal is to advance scientific knowledge of technology-based, behavioral HIV prevention, as well as improve public health by establishing the efficacy of an innovative eHealth prevention program for YMSM. We will accomplish these goals with three specific aims. First, we will integrate the KIU! intervention into a widely-used health technology platform to increase its scalability, adaptability, and potential for broad implementation. Second, we will test the efficacy of the KIU! eHealth intervention in a multisite RCT by: a) enrolling ethnically diverse YMSM (N = 750; > 65% racial/ethnic minorities) who tested HIV negative in the clinics of our community partners in Chicago and New York; b) randomizing participants to either the KIU! intervention or an HIV knowledge control condition; and c) measuring intervention outcomes at baseline and follow-up assessments at 3, 6, and 12 months. The primary behavioral outcome will be the count of unprotected anal sex acts and the primary biomedical outcome will be STI incidence. And third, we will explore if the KIU! intervention has differential efficacy across important sub-groups of YMSM based on race/ethnicity, relationship status (serious versus casual relationships), and gay/bisexual identity. Our KIU! approach is innovative in linking an eHealth solution to HIV and STI testing, as well as serving as model for integrating scalable behavioral prevention into other biomedical prevention strategies. PUBLIC HEALTH RELEVANCE: Men who have sex with men (MSM) are the largest HIV transmission group in the US and infections are increasing most among young MSM (18-24 years), however, few HIV prevention programs have been developed and proven effective with this vulnerable population. The overarching goal of this proposal is to improve public health by establishing the efficacy of an innovative, Internet-based HIV prevention program for YMSM.