Addressing the continuum of care among high-risk Thai men

项目摘要 在泰国，艾滋病毒在男男性行为者(YMSM)中的流行正在升级。 特别是，在泰国东北部，青年男性接触者中艾滋病毒的流行率估计为10%-15%。显然， 高危性行为正在发生，艾滋病毒检测的接受率仍然很低，即使是免费检测 服务由公立诊所提供。尽管提供了免费的抗逆转录病毒治疗(ART)，但 根据政府的调查，只有不到25%的艾滋病毒阳性青年男同性恋者(HIV+YMSM)仍在接受护理，这表明很少人 已经实现了病毒抑制。次优的艾滋病毒检测和治疗服务 YMSM在亟需的预防工作中构成了巨大的挑战，以改善与护理和 实现个人和社区的病毒抑制，防止艾滋病毒的进一步传播。社区 动员和赋权方法，针对个人、社会/社区和 需要卫生系统水平，以改善获得预防和治疗服务的机会，包括性服务 降低风险、艾滋病毒检测以及与护理连续体(CC)的联系和参与。基于一种文化 适应循证赋权干预，我们开发并试点了Hug-M，一个多 以理论为基础的层面干预，传播社会支持，有序地赋予YMSM社区权力 建立支持降低风险和一年两次的艾滋病毒检测的社会规范。Hug-M可以接受 YMSM在先前的试点研究中，可行实施，并有可能增加艾滋病毒检测和 减少性行为风险。拟议的研究将测试社区动员，多层次 在泰国东北部两个配对良好的城市进行干预。该项目的目标是：(1)敲定和 HUG-M+是一种社区动员、多组件、多层次、组合干预措施， 重点关注预防和护理的整个连续性，(2)实施Hug-M+，为期2年 与泰国公共卫生部(MOPH)诊所合作，提供艾滋病毒检测和 治疗，以及(3)评估Hug-M+在减少性危险行为方面的试点效果； 将艾滋病毒检测增加到至少两年一次；以及增加生活在 (A)泰国东北部两个城市的YMSM纵向队列感染艾滋病毒；过度抽样 HIV+YMSM，它将提供关于CC的数据，包括性危险行为；肛门细菌性传播疾病；艾滋病毒 检测频率；艾滋病毒/男男性接触者的护理参与度；(B)纵向公共卫生数据， 卫生部已经收集了这些数据，其中包括艾滋病毒患者的CD4和病毒载量数据。如果这位飞行员出现在 为了有效，可能会建议对其进行更大规模的后续多点研究。

Project Summary The HIV epidemic in Thailand is escalating among young men who have sex with men (YMSM). Particularly, HIV prevalence among YMSM is estimated to be 10-15% in Northeastern Thailand. Obviously high risk sexual behavior is occurring, and the uptake of HIV testing remains low even though free testing services are offered by public clinics. Despite provision of free antiretroviral treatment (ART) by the government, less than 25% of HIV-positive YMSM (HIV+YMSM) are retained in care, suggesting very few have achieved viral suppression. The suboptimal access to HIV testing and treatment services among YMSM pose tremendous challenge in much needed prevention efforts to improve linkage to care and achieve individual and community viral suppression to prevent onward HIV transmission. Community mobilization and an empowerment approach that targets barriers at individual, social/community, and health systems levels are needed to improve access to prevention and treatment services, including sexual risk reduction, HIV testing, and linkage and engagement in the care continuum (CC). Based on a cultural adaptation of the evidence-based Mpowerment intervention, we developed and piloted HUG-M, a multi- level, theory-based intervention that diffuses social support and empowers the YMSM community in order to establish social norms supportive of risk reduction and biannual HIV testing. HUG-M was acceptable to YMSM in a prior pilot study, feasible to implement, and has the potential to increase HIV testing and decrease sexual risk behavior. The proposed study will test a community mobilization, multi-level intervention in two well-matched cities in Northeastern Thailand. The project’s aims are: (1) to finalize and manualize HUG-M+, a community mobilization, multicomponent, multi-level, combination intervention that focuses on the entire Continuum of Prevention and Care, (2) to implement HUG-M+ for 2 years in collaboration with the Thailand Ministry of Public Health (MOPH) clinics that provide HIV testing and treatment, and (3) to evaluate the pilot efficacy of HUG-M+ in decreasing sexual risk behavior; increasing HIV testing to at least biannually; and increasing prompt, sustained engagement in care among men living with HIV by (a) longitudinal cohorts of YMSM in two cities in Northeastern Thailand; oversampling HIV+YMSM, which will provide data on the CC including sexual risk behavior; anal bacterial STIs; HIV testing frequency; and engagement in care among HIV+YMSM; and (b) longitudinal public health data, already collected by the MOPH, which include CD4 and viral load data for HIV patients. If this pilot is shown to be effective, a follow-up larger, multisite study of it may be proposed.