Evaluating the effectiveness of a mobile HIV prevention app to increase HIV and STI testing and PrEP initiation among rural men who have sex with men

摘要 农村男同性恋者(GBMSM)HIV感染和STI检测结果分析 美国南部的气温较低。然而，艾滋病毒和性传播感染检测是获得预防性服务的基本途径，例如 暴露前预防(PrEP)和治疗规定。因此，至关重要的是我们要找出方法来 在艾滋病毒和性传播感染不成比例的人群中增加艾滋病毒和性传播感染检测的接受率 发病率。我们开发了一款名为Combine的应用程序，这是对HealthMindr的改编，这款应用程序已经 证明了在提高城市GBMSM中艾滋病毒检测接受率方面的有效性。联合收割机被改编为 来自农村地区GBMSM的投入，以解决这一人群特有的问题，如增加经验 消除耻辱，减少获得有文化能力的护理的机会。我们建议进行类型2混合 有效性-实施随机对照试验以测试联合用药增加对 对HIV和STI进行超过24个月的跟踪检测，并检查不同实施方案的效果 在南方农村的GBMSM中的战略。Combine将包括自我管理风险的组件 评估，制定和支持艾滋病毒和性传播感染频繁检测计划，关于预防接种计划的信息，以及 PREP和HIV/STI检测提供者定位器。之前基于APP的艾滋病毒预防试验包括 能够订购免费的艾滋病毒和性传播感染自检试剂盒。然而，各地卫生官员之间并没有达成共识。 家庭自我检测是否是增加艾滋病毒和性传播感染检测的最佳解决方案。此外，尽管 免费的艾滋病毒和性传播感染自检试剂盒在以前的研究中，很大比例的男性仍然没有完成 艾滋病毒检测和更少的完整的性传播感染检测。因此，我们将评估两种不同干预措施的效果 2x2析因试验设计中HIV和STI吸收的成分：HIV和STI自检试剂盒的可用性 通过应用程序订购和旨在增强现有应用程序内容的激励性采访，增加 自我效能感：制定并贯彻测试计划，制定应对经验的策略 耻辱。所有参与者都将收到联合应用程序，其中包括一个用于识别附近艾滋病毒和性传播疾病的定位器 考试中心。控制臂(臂1)的男性将没有能力订购艾滋病毒和性传播感染自检试剂盒，并 不会接受励志面试；2号手臂的男性将没有能力订购艾滋病毒和性传播感染自检试剂盒 但将接受励志面试；3号手臂的男性将能够订购免费的艾滋病毒和性传播感染自检试剂盒，但 不会接受激励性面试；4号手臂的男性将有能力要求进行艾滋病毒和性传播感染自我检测 套件，并将接受励志面试。我们将评估艾滋病毒和性传播感染的主要影响 关于HIV和STI检测吸收、PrEP启动和干预的自测试剂盒和激励性访谈 维护超过24个月的跟踪。我们以社区为基础的合作伙伴，阿肯色州社区， 将在项目的所有阶段与我们合作，以确保我们正在获得必要的数据以告知 未来的实施。

Abstract Uptake of HIV and STI testing among gay and bisexual men who have sex with men (GBMSM) in the rural southern US is low. However, HIV and STI testing is a fundamental gateway to preventive services, such as pre-exposure prophylaxis (PrEP), and treatment provision. Thus, it is critical that we identify methods to increase uptake of HIV and STI testing among this population that experiences disproportionate HIV and STI incidence. We have developed an app, Combine, that is an adaptation of HealthMindr, an app that has demonstrated efficacy in increasing uptake of HIV testing among urban GBMSM. Combine was adapted using input from GBMSM in rural areas to address issues specific to this population such as increased experiences of stigma and reduced access to culturally competent care. We propose to conduct a Type 2 Hybrid Effectiveness-Implementation randomized controlled trial to test the efficacy of Combine to increase uptake of HIV and STI testing over 24 months of follow-up and to examine the effect of different implementation strategies among GBMSM in the rural South. Combine will include components for self-administered risk assessments, developing and supporting a plan for frequent HIV and STI testing, information about PrEP, and PrEP and HIV/STI testing provider locators. Previous trials of app-based HIV prevention have included the ability to order free HIV and STI self-test kits. However, there is not a consensus among health officials around whether at-home self-tests are an optimal solution for increasing HIV and STI testing. Additionally, despite the availability of free HIV and STI self-test kits in previous studies, large proportions of men still do not complete HIV tests and even fewer complete STI tests. Thus, we will evaluate the effect of two different intervention components on HIV and STI uptake in a 2x2 factorial trial design: availability of HIV and STI self-test kits ordered through the app and a motivational interview designed to enhance the existing app content, increase self-efficacy to develop and follow through with a testing plan, and develop strategies to deal with experiences of stigma. All participants will receive the Combine app, including a locator to identify nearby HIV and STI testing centers. Men in the control arm (Arm 1) will not have the ability to order HIV and STI self-test kits and will not receive a motivational interview; men in Arm 2 will not have the ability to order HIV and STI self-test kits but will receive a motivational interview; men in Arm 3 will be able to order free HIV and STI self-test kits but will not receive a motivational interview; and men in Arm 4 will have the ability to order HIV and STI self-test kits and will receive a motivational interview. We will assess the main effects of the availability of HIV and STI self-test kits and the motivational interview on HIV and STI testing uptake, PrEP initiation, and intervention maintenance over 24 months of follow up. Our community-based partner, Engaging Arkansas Communities, will work with us through all stages of the project to ensure that we are obtaining the necessary data to inform future implementation.