Implementation of a Sexual Health Intervention for YMSM in Two Vietnamese Cities

描述（由申请人提供）：监测和行为流行病学研究表明，越南的年轻男性性工作者（YMSW）与多个同时存在的伴侣（包括男性和女性伴侣）发生无保护性行为的比例很高，这导致了性传播感染和艾滋病毒的高发病率，并扩大了本已很高的艾滋病毒发病率。对现有预防方案的了解程度很低，在艾滋病毒知识和减少性风险技能方面存在重大差距。现有的社区外展活动主要针对同性恋身份的YMSM。此外，由于在医疗保健环境中存在严重的污名化和歧视风险，YMSW很少参与和保留保护性医疗服务（包括性传播感染/艾滋病毒筛查，HBV/HPV疫苗接种，以及与艾滋病毒护理的早期联系）。在过去的八年里，我们的美国/越南合作研究小组一直在高风险青年人群（包括YMSW）中进行NIDA资助的艾滋病毒研究。在我们先前工作中取得的大量研究能力和卫生服务基础设施的基础上，我们建议通过在越南两个战略选定的城市（河内和胡志明市）实施针对YMSW的综合干预方案，解决社区外展和卫生服务获取方面的差距。利用性健康促进作为一个概念框架，我们将结合联合收割机已经证明的干预技术-社区外展护理和性健康促进干预-以提高外展覆盖率，并促进参与和保留在卫生服务。将实现很大程度的外联覆盖（估计有12 000个外联联系人），并将提供大量保健服务（2 400名保健服务参与者）。使用混合方法的方法，包括人类学民族志，社会和行为流行病学，和卫生服务评估，过程和结果的评估，社区外展和卫生服务干预将进行。在实施社区外展和保健服务干预措施之前和之后进行的反复横断面调查将记录社区一级外展接触的增加、对艾滋病毒行为风险的知识和认识的增加、减少性风险的技能的提高以及对诊所性健康促进干预措施的参与，从而表明有效参与和保留保健服务。实施科学特别感兴趣的是，定性和定量分析将评估城市之间在干预措施的吸收和有效性方面的差异，这些数据将使我们了解干预措施的影响，适应性和普遍性，并指导未来的传播。 公共卫生相关性：越南年轻男性性工作者艾滋病毒和其他性传播感染的流行率很高，反映出他们同时与男性和女性伴侣进行多次性交易，但他们接触或参与卫生服务的机会有限，包括社区外展，艾滋病毒/性传播感染检测和治疗，以及乙肝和HPV疫苗接种。在我们之前在越南的研究合作中开发的大量研究能力和卫生服务基础设施的基础上，我们建议通过使用性健康促进作为概念框架来解决社区外展和卫生服务获取方面的这些差距。以及基于实施科学原则的研究设计，以提供结合已被证明的干预技术的干预措施-社区外展护理和性健康促进干预措施-在越南两个战略性选定的城市（河内和胡志明市），扩大外展覆盖面，促进青年男社工参与和保持健康服务。预计该干预将大大有助于越南的干预能力建设，并可能有助于面临类似挑战的东南亚邻国的干预发展。

DESCRIPTION (provided by applicant): Both surveillance and behavioral epidemiological studies show that young male sex workers (YMSWs) in Vietnam have high rates of unprotected sex with multiple, concurrent partners - including both male and female partners - contributing to high rates of STIs and HIV and amplifying already high HIV incidence. Exposure to existing prevention programming is low, with major gaps in HIV knowledge and sexual risk reduction skills. Existing community outreach activities have primarily reached gay-identified YMSM. Moreover, owing to profound risk for stigma and discrimination in health care settings, few YMSW are engaged and retained in protective health services (including STI/HIV screening, HBV/HPV vaccination, and early linkages to HIV care). Our collaborative US/Vietnam research team has been conducting NIDA-funded HIV research among high risk youth populations, including YMSWs, for the past eight years. Building on the substantial research capacity and health services infrastructure that has been achieved in our prior work, we propose to address these gaps in community outreach and health services access by implementing a composite intervention package targeted to YMSWs in the two strategically selected cities in Vietnam (Hanoi and Ho Chi Minh City). Using Sexual Health Promotion as a conceptual framework, we will combine already proven intervention technologies - community outreach nursing and sexual health promotion interventions - to enhance outreach coverage and to foster engagement and retention in health services. Significant levels of outreach coverage will be achieved (with an estimated 12,000 outreach contacts) and substantial numbers of health services will be delivered (2,400 health services participants). Using a mixed-methods approach that includes anthropological ethnography, social and behavioral epidemiology, and health services assessments, process and outcomes evaluation of both the community outreach and health services intervention will be undertaken. Repeated cross-sectional surveys, administered both prior to and following implementation of the community outreach and health services intervention, will document community-level increases in exposure to outreach, increased knowledge and awareness of behavioral HIV risk, increased sexual risk reduction skills and participation in the clinic-based sexual health promotion intervention, thus demonstrating effective engagement and retention in health services. Of particular interest to implementation science, both qualitative and quantitative analysis will assess between-city differences in intervention uptake and effectiveness, data that will inform our understanding of the impact, adaptability, and generalizability of the intervention and guide future dissemination. PUBLIC HEALTH RELEVANCE: Young male sex workers in Vietnam show high prevalence rates of HIV and other STIs, reflecting their involvement in multiple concurrent sex exchanges with both male and female partners, yet they have limited exposure to, or engagement in, health services, including community outreach, HIV/STI testing and treatment, and vaccination for HBV and HPV. Building on the substantial research capacity and health services infrastructure developed in our prior research collaboration in Vietnam, we propose to address these gaps in community outreach and health services access by using Sexual Health Promotion as a conceptual framework, and a research design based on principles of implementation science to deliver an intervention that combines already proven intervention technologies - community outreach nursing and sexual health promotion interventions - to enhance outreach coverage and to foster engagement and retention in health services among YMSWs in the two strategically selected cities in Vietnam (Hanoi and Ho Chi Minh City). It is anticipated that the intervention will significantly contribute to intervention capacity-building in Vietnam and may als contribute to intervention development in neighboring countries in Southeast Asia that face similar challenges.