Integration of Electronic SBI(RT) into an HIV Testing Program to Reduce Substance Use and HIV risk Behavior among MSM in Argentina

在美国，男男性行为者（MSM）受到艾滋病毒和药物滥用的严重影响， 欧洲和拉丁美洲。然而，在一般人群中，识别和参与MSM与 有问题的物质使用（PSU）的治疗是一个重大的挑战，这导致了绝大多数 患有PSU的MSM从未接受过治疗。物质滥用和精神健康服务管理局 （SAMHSA）建议筛查（S），短暂干预（BI）和转诊治疗（RT; SBIRT）作为 对有酗酒和吸毒风险的非寻求治疗的个人进行早期干预， 为患有药物使用障碍的人提供更密集的药物滥用治疗。需要这种 干预在阿根廷和拉丁美洲尤为严重，那里几乎没有实施 对患有PSU的MSM进行循证干预。拟议的研究旨在通过以下方式解决这一明显差距： 开发并试行一项专为等待在Nexo协会进行艾滋病毒检测的男男性接触者量身定制的电子SBI计划 Civil是我们在布宜诺斯艾利斯的社区合作伙伴。基于平板电脑的e-SBI将整合物质使用和性行为 风险行为筛选器和个性化定制的动机面试（MI）作为BI。我们也会适应， 试行青年男子健康项目（YMHP，现为MHP，因为它将不仅限于青年人， MSM），一个四届MI为基础的干预，有效地减少了物质使用和无避孕套肛门 Nexo为中度MSM参与者提供的短暂治疗是使用MSM物质的性交 或使用高风险药物这项R34研究的具体目标是：1）开发定制的e-SBI干预措施 在艾滋病毒检测的背景下，旨在减少物质使用和艾滋病毒风险行为（主要）; 2）评估 将e-SBI纳入Nexo的艾滋病毒检测流程的可行性和可接受性，通过a） Nexo接受研究的MSM测试客户的百分比; B）完成研究的参与者的百分比 e-SBI; c）e-SBI可接受性评级（初级）; 3）评估实施适应的可行性和可接受性 Nexo的YMHP，通过以下方式衡量：a）使用中度或高度风险物质的MSM进入 和/或完成MHP; B）接受MHP的人对MHP的接受程度;以及c）课程的百分比 由符合MI忠诚度标准的每位MHP顾问进行（次要）。在第一阶段（发展），我们 我将开发e-SBI，使YMHP适应MHP，培训MHP顾问，并在50名MSM中试用e-SBI 进行艾滋病毒检测在第2阶段（RCT试点），我们将以3：1的比例随机抽取200名MSM到Nexo进行HIV检测 (eSBI：筛选评估（SA），以评估e-SBI在即将到来的MSM中的可行性和可接受性 Nexo进行HIV检测，并为未来的试验建立和试点RCT流程。作为次要目标，我们将 评估向低风险或中等风险物质的参与者提供MHP的吸收率、可接受性和可行性 使用高风险药物的参与者中使用药物并随后转介接受药物滥用治疗，或 依赖最后，我们将探讨药物使用和性风险降低结果的初步结果。

Men who have sex with men (MSM) are disproportionally affected by HIV and substance abuse in the U.S., Europe, and Latin America. However, as in the general population, identifying and engaging MSM with problematic substance use (PSU) into treatment is a significant challenge, which results in the great majority of MSM with PSU never receiving treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends Screening (S), Brief Intervention (BI), and Referral to Treatment (RT; SBIRT) as an early intervention for non-treatment-seeking individuals with risky alcohol and drug use, as well as the timely referral to more intensive substance abuse treatment for those with substance use disorders. The need for such an intervention is particularly acute in Argentina and Latin America, where there is little implementation of evidence-based interventions for MSM with PSU. The proposed study seeks to address this glaring gap by developing and piloting an electronic-SBI program tailored for MSM awaiting their HIV test at Nexo Asociacion Civil, our community partners in Buenos Aires. The tablet-based e-SBI will integrate substance use and sexual risk behavior screeners and individually tailored Motivational Interviewing (MI) as the BI. We will also adapt and pilot the implementation of the Young Men’s Health Project (YMHP, now MHP since it will not be limited to young MSM), a four-session MI-based intervention that effectively reduced substance use and condomless anal intercourse among substance using MSM, as a brief treatment provided at Nexo for participants with moderate or high-risk substance use. The Specific Aims of this R34 study are to: 1) develop a tailored e-SBI intervention for MSM in an HIV testing context aimed at reducing substance use and HIV risk behavior (Primary); 2) assess the feasibility and acceptability of integrating e-SBI into the HIV testing process at Nexo as measured by a) percent of MSM testing clients at Nexo who accept entry into the study; b) percent of participants who complete e-SBI; c) e-SBI acceptability ratings (Primary); 3) assess the feasibility and acceptability of implementing adapted YMHP at Nexo, as measured by a) the percent of MSM with moderate or high-risk substance use who enter and/or complete MHP; b) acceptability of MHP among those who received it; and c) percentage of sessions conducted by each MHP counselor that meets criteria for MI fidelity (Secondary). In Stage 1 (Development) we will develop e-SBI, adapt YMHP into MHP, train MHP counselors, and pilot e-SBI with 50 MSM coming to Nexo for HIV testing. In Stage 2 (RCT Pilot), we will randomize 200 MSM coming to Nexo for HIV testing at a 3:1 ratio (eSBI: Screening Assessments Only-SA) to assess the feasibility and acceptability of e-SBI among MSM coming to Nexo for HIV testing and establish and pilot the RCT process for a future trial. As a secondary aim, we will assess uptake, acceptability, and feasibility of delivering MHP to participants with low or moderate risk substance use and subsequent referrals to substance abuse treatment among participants with high-risk substance use or dependence. Lastly, we will explore preliminary findings on substance use and sexual risk reduction outcomes.