Patel Viraj V, Ginsburg Zoë, Golub Sarit A, Horvath Keith J, Rios Nataly, Mayer Kenneth H, Kim Ryung S, Arnsten Julia H
Division of General Internal Medicine, Department of Medicine, Montefiore Health System / Albert Einstein College of Medicine, Bronx, NY, United States.
Department of Family Medicine, Swedish Cherry Hill Campus, Swedish Medical Center, Seattle, WA, United States.
JMIR Res Protoc. 2018 Aug 28;7(8):e11375. doi: 10.2196/11375.
Young black and Latinx, gay, bisexual, and other men who have sex with men (YBLGBM, aged 18-29 years) have among the highest rates of new HIV infections in the United States and are not consistently reached by existing prevention interventions. Preexposure prophylaxis (PrEP), an oral antiretroviral regimen taken daily by HIV-uninfected individuals to prevent HIV acquisition, is highly efficacious in reducing HIV acquisition and could help stop the HIV epidemic in YBLGBM. Use of social media (eg, Facebook, Twitter, online dating sites) is ubiquitous among young people, providing an efficient avenue to engage YBLGBM to facilitate PrEP adoption.
Our overall goal was to develop and pilot test a theoretically grounded, social media-based, peer-led intervention to increase PrEP uptake in YBLGBM. We used diffusion of innovation and information-motivation-behavioral skills frameworks to (1) identify potential factors associated with interest in and adoption of PrEP among YBLGBM; (2) develop Empowering with PrEP (E-PrEP), a social media-based, peer-led intervention to increase PrEP uptake in YBLGBM; and (3) pilot test the feasibility and acceptability of E-PrEP, and determine its preliminary efficacy for increasing adoption of PrEP by YBLGBM. We describe the development and protocol for E-PrEP.
Using a participatory research approach, we partnered with YBLGBM intervention development partners to develop a social media-based behavioral intervention to facilitate PrEP uptake, which involved an online messaging campaign disseminated by YBLGBM peer leaders to their existing online networks. We designed the 6-week campaign to provide education about PrEP, increase motivation to use PrEP, and facilitate access to PrEP. We then conducted a cluster-randomized trial of E-PrEP compared with an attention-matched general health control condition (E-Health) among YBLGBM aged 18 to 29 years to assess E-PrEP's feasibility, acceptability, preliminary efficacy for increasing self-reported intention to use PrEP, PrEP uptake, and impact on knowledge and attitudes about PrEP at 12-week follow-up (6 weeks after the end of the online campaign).
From October 2016 to March 2017, we developed, pretested, and refined E-PrEP with 6 YBLGBM intervention development partners. From May to June 2017, we recruited, enrolled, and randomly assigned 10 peer leaders (n=5 for each condition). The 10 peer leaders then recruited and enrolled 152 participants from their existing online networks (range 3-33 per peer leader), during June and July 2017. Intervention follow-up was completed after 12 weeks, in November 2017, with analyses underway.
We hypothesize that, compared with E-Health, participants randomly assigned to E-PrEP will be more likely to express intention to use PrEP and greater PrEP uptake, and will also show changes in potential mediators of PrEP uptake (knowledge, attitudes, stigma, and access). A Web-based biobehavioral intervention model such as E-PrEP could be rapidly scaled even with limited resources and have significant population-level impact.
ClinicalTrials.gov NCT03213366; https://clinicaltrials.gov/ct2/show/NCT03213366 (Archived by WebCite at http://www.webcitation.org/71onSdcXY).
RR1-10.2196/11375.
年轻的黑人及拉丁裔男同性恋、双性恋和其他与男性发生性关系的男性（18至29岁的YBLGBM）在美国新增艾滋病毒感染率最高，现有预防干预措施未能始终覆盖到他们。暴露前预防（PrEP）是未感染艾滋病毒的个体每日服用的口服抗逆转录病毒疗法，用于预防艾滋病毒感染，在降低艾滋病毒感染方面非常有效，有助于阻止YBLGBM群体中的艾滋病毒流行。社交媒体（如脸书、推特、在线约会网站）在年轻人中广泛使用，为吸引YBLGBM群体以促进PrEP的采用提供了有效途径。
我们的总体目标是开发并进行理论基础扎实、基于社交媒体且由同伴主导的干预措施，以提高YBLGBM群体对PrEP的接受率。我们运用创新扩散理论和信息-动机-行为技能框架来（1）确定与YBLGBM群体对PrEP的兴趣和采用相关的潜在因素；（2）开发“PrEP赋能”（E-PrEP），这是一种基于社交媒体且由同伴主导的干预措施，以提高YBLGBM群体对PrEP的接受率；（3）对E-PrEP的可行性和可接受性进行试点测试，并确定其在提高YBLGBM群体采用PrEP方面的初步效果。我们描述了E-PrEP的开发过程和方案。
采用参与式研究方法，我们与YBLGBM干预措施开发合作伙伴合作，开发一种基于社交媒体的行为干预措施以促进PrEP的采用，其中包括由YBLGBM同伴领袖向其现有的在线网络传播的在线信息宣传活动。我们设计了为期6周的宣传活动，以提供关于PrEP的教育、增强使用PrEP的动机并促进PrEP的获取。然后，我们在18至29岁的YBLGBM群体中进行了E-PrEP与注意力匹配的一般健康对照条件（电子健康）的整群随机试验，以评估E-PrEP的可行性、可接受性、在增加自我报告的使用PrEP意愿方面的初步效果、PrEP的采用情况以及在12周随访（在线宣传活动结束后6周）时对PrEP知识和态度的影响。
2016年10月至2017年3月，我们与6名YBLGBM干预措施开发合作伙伴共同开发、预测试并完善了E-PrEP。2017年5月至6月，我们招募、登记并随机分配了10名同伴领袖（每组5名）。这10名同伴领袖随后在2017年6月至7月期间从他们现有的在线网络中招募并登记了152名参与者（每名同伴领袖招募3至33名）。干预措施的随访在12周后于2017年11月完成并正在进行分析。
我们假设，与电子健康相比，随机分配到E-PrEP的参与者更有可能表达使用PrEP的意愿并更高程度地采用PrEP，并且还将在PrEP采用的潜在中介因素（知识、态度、耻辱感和获取途径）方面表现出变化。像E-PrEP这样基于网络的生物行为干预模型即使在资源有限的情况下也可以迅速扩大规模，并产生重大的群体层面影响。
ClinicalTrials.gov NCT03213366；https://clinicaltrials.gov/ct2/show/NCT03213366（由WebCite存档于http://www.webcitation.org/71onSdcXY）。
RR1 - 10.2196/11375。
