Peer-driven Intervention to Seek, Test & Treat Heterosexuals at High Risk for HIV

描述(由申请人提供)：在美国，大约21%的艾滋病毒感染没有得到诊断，但只有大约40%的成年人接受了检测。因此，艾滋病毒的延迟诊断很常见，此外，治疗延误和中断也很普遍。与其他群体相比，高危异性恋者检测艾滋病毒的可能性大大降低，更有可能被诊断为艾滋病毒晚期，并且在进入护理方面遇到了严重的障碍。作为疾控中心国家艾滋病毒行为监测(NHBS)研究的一部分，我们的研究团队研究了纽约市(NYC)的HHR。我们发现，在纽约市的HHR中，艾滋病毒的流行率为7.4%，而这些感染中只有6%之前被诊断出来。此外，在布鲁克林中部，10%的人新被诊断为艾滋病毒携带者。拟议的研究将使用NHBS方法来针对HHR。HHR中艾滋病毒检测和治疗率下降的原因是结构性障碍(例如，获得机会较少)、社会障碍(例如，同伴规范)和个人层面的障碍(例如，感知风险较低)。因此，需要效仿NHBS的积极招募办法来克服结构性障碍，同行提供的干预措施有效地减少了检测和治疗方面的个人和社会障碍。这项拟议研究的主要目标是评估多水平增强型同行驱动干预(PDI)在寻找、测试、治疗和保留HHR方面的效果。增强型PDI是专门为HHR量身定做的，包括计算机化、导航和同行交付组件，以增强未来的可持续性。干预的设计以三元影响理论和规范规制理论为指导。与NHBS类似，增强型PDI将使用受访者驱动抽样(RDS)。NHBS方案使用基于场所的抽样(VBS)和RDS来接触高危人群。然而，VBS和RDS在未诊断的艾滋病毒感染方面尚未进行直接比较。因此，这项为期五年的拟议研究的具体目标是：(1)比较RDS和VBS的产量和效率，以确定HHR中未诊断的HIV感染；(2)在HIV护理和HAART启动时间、病毒载量抑制和新诊断患者滞留方面，衡量增强PDI与对照组相比的有效性；(3)研究个人发展指数(PDI)对艾滋病毒健康/治疗结果的影响是否由个人(如感知风险)、社会(如同伴规范)和结构性影响(如更容易获得)的变化所中介，和/或其他因素(如物质使用)是否缓和其影响；及(4)预测RDS与VBS和PDI的成本和成本效益。我们将在布鲁克林中部进行增强型PDI(N=3000)，布鲁克林是艾滋病毒高度流行的地区，HHR在那里很难获得检测和治疗。同时，VBS(N=400)将在布鲁克林市中心进行。拟议的研究是对地方和国家艾滋病毒预防举措的补充，旨在为艾滋病毒预防工作提供一种高效、创新和可持续的多层次招聘方法和干预措施。HHR的绝大多数是非洲裔美国人或拉丁美洲人；因此，拟议的研究还可能影响艾滋病毒/艾滋病方面的种族/族裔差异。 公共卫生相关性：与其他风险群体相比，高危异性恋者接受艾滋病毒检测的可能性明显较低，检测频率较低，并且更有可能较晚被诊断为艾滋病毒。拟议研究的总体目标是开发一种高效、创新和可持续的多层次招聘方法和干预艾滋病毒预防组合。由于HHR的绝大多数是非裔美国人或拉丁裔，该项目在减少艾滋病毒/艾滋病方面的种族/民族差异方面具有很大的潜力。

DESCRIPTION (provided by applicant): Approximately 21% of HIV infections in the U.S. are undiagnosed, but only about 40% of all adults have been tested. Thus, late diagnosis of HIV is common, and, furthermore, treatment delays and disruptions are widespread. Heterosexuals at high risk (HHR) are significantly less likely to test for HIV, are more likely to be diagnosed with HIV late, and experience serious barriers to entering care compared to other groups. Our research team has studied HHR in New York City (NYC) as part of the CDC's National HIV Behavioral Surveillance (NHBS) studies. We found an HIV prevalence rate of 7.4% among HHR in NYC, and only 6% of these infections had been previously diagnosed. Further, in central Brooklyn, 10% were newly diagnosed with HIV. The proposed study will use NHBS methodology to target HHR. Reduced rates of HIV testing and treatment among HHR are due to structural (e.g., poor access), social (e.g., peer norms), and individual-level (e.g., low perceived risk) barriers. Thus active recruitment approaches modeled after NHBS are needed to overcome structural barriers, and peer-delivered interventions effectively reduce individual and social barriers to testing and treatment. The primary goal of the proposed study is to evaluate the efficacy of a multi-level enhanced peer-driven intervention (PDI) to seek, test, treat and retain HHR. The enhanced PDI is tailored specifically for HHR and includes computerized, navigation, and peer-delivered components to enhance future sustainability. The design of the intervention is guided by the Theories of Triadic Influence and Normative Regulation. Similar to NHBS, the enhanced PDI will use respondent-driven sampling (RDS). NHBS protocols use both venue-based sampling (VBS) and RDS for reaching populations at high risk. However, VBS and RDS have not yet been directly compared in terms of their yield of undiagnosed HIV infections. Thus the specific aims of this five-year proposed study are to: (1) compare the yield and efficiency of RDS and VBS to identify undiagnosed HIV infection among HHR; (2) measure the efficacy of an enhanced PDI compared to a control in terms of time to HIV care and HAART initiation, viral load suppression, and retention among those newly diagnosed; (3) examine whether the effects of the PDI on HIV health/treatment outcomes are mediated by changes in individual (e.g., perceived risk), social (e.g., peer norms), and structural influences (e.g., enhanced access), and/or whether other factors (e.g., substance use) moderate its effects; and (4) to project the costs and cost-effectiveness of RDS vs. VBS and PDI. We will conduct the enhanced PDI (N=3000) in central Brooklyn, a location hyperendemic for HIV and where HHR experience poor access to testing and treatment. Simultaneously, VBS (N=400) will be undertaken in central Brooklyn. The proposed study complements local and national HIV prevention initiatives and is designed to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. The vast majority of HHR are African-American or Latino; therefore the proposed study may also impact racial/ethnic disparities in HIV/AIDS. PUBLIC HEALTH RELEVANCE: Heterosexuals at high risk (HHR) are significantly less likely to have been tested for HIV, do not test as frequently, and are more likely to be diagnosed with HIV late compared to other risk groups. The overarching aim of the proposed research is to develop an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. Because the vast majority of HHR are African-American or Latino, the project has great potential to reduce racial/ethnic disparities in HIV/AIDS.