Development and Evaluation of a Multilevel, Socio-Culturally Contextualized Digital Health Decision Intervention to Reduce Medical Mistrust and Improve Status-Neutral HIV Service Use among HLMSM

项目摘要/摘要： 艾滋病毒对西班牙裔/拉丁裔男同性恋者、双性恋者和其他男男性行为者(HLMSM)的影响不成比例， 威胁着结束艾滋病毒流行(EHE)计划2030年目标的进展。医疗不信任(MM) 在与减少参与艾滋病毒预防和治疗服务有关的HLMSM中， 已被确定为维持和加剧艾滋病毒不平等的重要根本原因和驱动因素 HLMSM。因此，研究旨在了解和解决影响MM和HIV服务可信度的因素 (MMT)在HLMSM中艾滋病毒发病率上升的关键地区代表着公共卫生优先事项 推动在实现国家EHE目标方面取得进展。在整个拟议的项目中，HLMSM领导 调查小组将与由HLMSM、社区领导人和Strong 社区与西班牙裔/拉丁裔(H/L)社区和为HLMSM提供服务的医疗保健提供者HLMSM建立了联系， 具有与拟议研究活动和方法相关的学科专业知识的学术合作伙伴、媒体和 与HLMSM社区有密切联系的沟通伙伴，以及其他关键利益相关者。这个 该项目包括两个综合研究阶段，重点放在五个地理区域--加利福尼亚州洛杉矶县； 纽约州布朗克斯县、德克萨斯州贝克萨尔县、佛罗里达州迈阿密戴德县和PR圣胡安穆尼西皮奥-与 这是美国HLMSM中艾滋病毒发病率的一个重要负担。 在第一阶段，我们将进行形成性研究，为多层次数字健康的发展提供信息 干预措施，并确定针对高级别管理人员中的多发性硬化症的现有地方干预措施，包括：(1)深入开展 与N=60名不同的HLMSM进行访谈，探索形成MMT和HIV服务的根本原因和途径 使用概念的有效性、验证性和可靠性来通知定量测量方案；(2) 重点小组(每个地区2-3个)，N=6-8个HLMSM，探索可接受性、可行性和偏好 关于数字MMT干预以及参与者招募和留住方法的观点；(3) 采访N=50名主要线人(艾滋病毒服务提供者、H/L社区领袖、地方民选官员) 关于他们在HLMSM中使用MM的经验，当地和组织法律/政策，有助于 MMT，以及减少HLMSM中MM的建议；以及(4)一项横断面在线调查， N=1,625名HLMSM探索MMT和HIV服务使用的相关性。在第二阶段，我们将进行三臂 (1：1：1)平行解释性随机对照试验 解决MMT问题，改善HLMSM中地位中立的艾滋病毒服务的使用情况。N=336 HLMSM将为 从五个项目地域(总共N=1,680个)中的每一个征聘，并随机分配到 单独的多级数字干预(交互式网络平台和可下载的干预工作簿和 工具包)，或多级别数字干预加同行导航(远程医疗组件，参与者和 HLMSM同行导航员)，或护理标准(转诊至现有的当地艾滋病毒预防/治疗服务)。

Project Summary/Abstract: HIV disproportionately affects Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM), threatening progress toward the Ending the HIV Endemic (EHE) initiative’s 2030 goals. Medical mistrust (MM) among HLMSM, which is associated with reduced engagement with HIV prevention and treatment services, has been identified as an important root cause and driver in sustaining and exacerbating HIV inequities among HLMSM. Thus, research to understand and address factors that shape MM and HIV service trustworthiness (MMT) in key geographies of elevated HIV incidence among HLMSM represents a public health priority to enable progress toward meeting national EHE goals. Throughout the proposed project, the HLMSM-led investigative team will partner with a steering committee consisting of HLMSM, community leaders with strong community ties to the Hispanic/Latino (H/L) community and HLMSM, healthcare providers who serve HLMSM, academic partners with subject expertise relevant to the proposed study activities and methods, media and communication partners with strong connections to the HLMSM community, and other key stakeholders. The project consists of two integrated study phases focusing on five geographic areas — Los Angeles County, CA; Bronx County, NY; Bexar County, TX; Miami-Dade County, FL; and San Juan Municipio, PR — that align with EHE priority jurisdictions and account for a significant burden of HIV incidence among HLMSM across the US. During Phase I, we will conduct formative research to inform the development of a multilevel digital health intervention and to identify existing local interventions that address MM among HLMSM, including (1) in-depth interviews with N=60 diverse HLMSM exploring the root causes and pathways shaping MMT and HIV service use as well as concept validity, verification, and reliability to inform quantitative measurement protocols; (2) focus groups (2-3 per geography) with N=6-8 HLMSM exploring acceptability and feasibility of and preferences for a digital MMT intervention as well as perspectives on participant recruitment and retention methods; (3) interviews with N=50 key informants (HIV service providers, H/L community leaders, local elected officials) about their experiences with MM among HLMSM, local and organizational laws/policies that contribute to MMT, and recommendations for decreasing MM among HLMSM; and (4) a cross-sectional online survey with N=1,625 HLMSM exploring correlates of MMT and HIV service use. In Phase II, we will conduct a three-arm (1:1:1) parallel explanatory randomized control trial to evaluate the efficacy of our digital health intervention in addressing MMT and improving use of status-neutral HIV services among HLMSM. N=336 HLMSM will be recruited from each of the five project geographies (N=1,680 total) and randomly assigned to receive either the multilevel digital intervention alone (interactive web platform and downloadable intervention workbook and toolkit), or multilevel digital intervention plus peer navigation (telehealth component with participants and an HLMSM peer navigator), or the standard of care (referral to existing local HIV prevention/treatment services).