Expanding "Safe Spaces 4 Sexual Health," a Mobile Van HIV/STI Testing and Care Linkage Strategy, for Black MSM in online spaces

项目摘要 结束艾滋病毒流行取决于制定针对艾滋病毒的创新、战略性和量身定做的方法 诊断、治疗和预防。虽然新的艾滋病毒诊断病例从峰值大幅下降， 进展停滞不前，特别是在与留下来的男性(MSM)发生性关系的黑人男性中 在美国受到不成比例的影响。在初步研究中，安全空间4性健康(SS4SH)，我们 论证了地位中立的艾滋病毒/性传播感染检测方法的可行性和可接受性，该方法在以下方面确定- 在线空间中存在MSM风险，并将它们链接到马里兰州巴尔的摩的一辆移动面包车上的测试服务。专注于 在传统的寻求-测试-治疗策略可能会错过的在线空间中接触到MSM，我们的试点达到了 15 1名男男性接触者在14个月内被确诊为艾滋病病毒感染者(7%比0.5%，P&lt；0.001)。 与标准护理卫生部门(HD)相比，梅毒阳性率(10%比0.5%，P&lt；0.001) SoC)移动面包车战略。SS4SH Pilot没有评估参与者与PrEP或HIV护理的联系，这是 EHE战略的主要支柱。拟议的R21的目标是扩大试点研究，以整合 PREP和HIV护理联系，评估这一扩展战略的可接受性和可行性，并在准 实验设计，生成此策略与HD SOC相比的有效性的初步数据 流动面包车。具体目标是：1)使用基于社区的参与式方法，将SS4SH扩展到 将艾滋病毒感染高危黑人男男性接触者纳入PrEP，并将其与HIV护理联系起来 未诊断/未抑制的艾滋病毒携带者，以及2)使用准实验设计，试点扩大的 SS4SH测试加关爱联动策略：(1)评估增加关爱联动的可接受性和可行性 以及(2)生成关于扩展的SS4SH与HD SOC移动设备相比的有效性的初步数据 VAN由REACH、检测结果的再现性和护理关联结果测量来定义。目标1将 涉及定性的形成工作，包括焦点小组和对黑人MSM和KEY的深入访谈 线人与护理联系利益相关者的访谈，以探索环境和患者层面的护理障碍 建立联系并制定社区参与的联系战略，以克服这些障碍。社区咨询 董事会(CAB)，由从焦点小组招募的黑人MSM和面试参与者组成，将提供 成员检查研究小组对定性数据的解释，并与研究小组合作以 发展SS4SH的扩展，以便在目标2试点期间实施护理联动。在目标2中，我们将 招募男男性接触者(18-49岁)，在8个月内进行流动面包车艾滋病毒/性传播感染检测/护理联系。我们将评估结果 衡量提供护理联系的可行性和可接受性，并生成关于 SS4SH与HD SOC移动面包车策略的有效性比较。拟议的研究具有 为优先考虑黑人MSM的公共卫生战略提供信息的潜力，并有可能减少正在进行的艾滋病毒 通过接触到有感染和传播风险的人，并将他们与护理联系起来，使他们之间的差距更加明显。

Project Summary Ending the HIV epidemic (EHE) depends on developing innovative, strategic and tailored approaches to HIV diagnosis, treatment and prevention. While new HIV diagnoses have declined significantly from their peak, progress has stalled, particularly among Black men who have sex with men (MSM) who remain disproportionately affected in the US. In the pilot study, Safe Spaces 4 Sexual Health (SS4SH), we demonstrated the feasibility and acceptability of a status-neutral HIV/STI testing approach which identified at- risk MSM in online spaces and linked them to testing services on a mobile van in Baltimore, MD. Focusing on reaching MSM in online spaces who may be missed by traditional seek-test-treat strategies, our pilot reached 151 MSM over 14 months and demonstrated a significantly higher new HIV diagnosis (7% vs. 0.5%, p<0.001) and syphilis positivity rate (10% vs. 0.5%, p<0.001) compared to the standard of care health department (HD SOC) mobile van strategy. SS4SH pilot did not evaluate participants’ linkage to PrEP or HIV care, which are key pillars of the EHE strategy. The objective of this proposed R21 is to expand the pilot study to integrate PrEP and HIV care linkage, evaluate the acceptability and feasibility of this expanded strategy and in a quasi- experimental design, generate preliminary data on the effectiveness of this strategy compared to the HD SOC mobile van. The specific aims are: 1) Using a community-based participatory approach, expand SS4SH to incorporate linkage to PrEP for Black MSM at high risk for HIV acquisition and linkage to HIV care for those living with undiagnosed/unsuppressed HIV, and 2) Using a quasi-experimental design, pilot the expanded SS4SH testing plus care linkage strategy to (1) evaluate the acceptability and feasibility of adding care linkage and (2) generate preliminary data on effectiveness of the expanded SS4SH compared to the HD SOC mobile van as defined by reach, reproducibility of testing outcomes, and care linkage outcome measures. Aim 1 will involve qualitative formative work including focus groups and in-depth interviews with Black MSM and key informant interviews with care linkage stakeholders to explore environmental and patient level barriers to care linkage and develop community engaged linkage strategies to overcome these barriers. A community advisory board (CAB), composed of Black MSM recruited from focus group and interview participants will provide member-checking of the study team’s interpretations of qualitative data and partner with the study team to develop the expansion of SS4SH for care linkage to be implemented during the Aim 2 pilot. In Aim 2, we will recruit MSM (ages 18-49) for mobile van HIV/STI testing/care linkage over 8 months. We will evaluate outcome measures of feasibility and acceptability of providing care linkage and generate preliminary data on the effectiveness of the SS4SH compared to the HD SOC mobile van strategy. The proposed research has the potential to inform public health strategies prioritizing Black MSM and potentially reduce ongoing HIV disparities by reaching both those at risk for acquisition and transmission and linking them to care.