The Fenway Institute, Fenway Health, Boston, MA, USA.
The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Lancet HIV. 2021 Dec;8(12):e776-e786. doi: 10.1016/S2352-3018(21)00241-1. Epub 2021 Oct 22.
Disparities persist along the HIV care continuum among Black men who have sex with men (MSM) in the USA. As part of an initiative funded by the Health Resources and Services Administration's HIV/AIDS Bureau (US Department of Health and Human Services), we searched for recently published interventions focused on improving HIV care continuum outcomes among Black MSM with HIV in the USA. Our search identified 14 interventions, all of which were associated with at least one statistically significant outcome. Medication adherence was the most common outcome of interest, and linkage to care was the least common. More than half of the interventions focused on younger populations and took place in the US South. Interventions used a range of strategies to increase cultural relevance and address common barriers to optimal HIV outcomes for Black MSM. Several interventions harnessed social media, text messaging, and smartphone apps to facilitate social support, deliver HIV education, and encourage medication adherence. Interventions were delivered mostly at the individual or interpersonal level, although three made system-level changes to address structural barriers. Notably missing were interventions focused on minimising behavioural health barriers, and interventions directly addressing social determinants of health such as housing. To accelerate the pace of implementation and scale-up of interventions for Black MSM with HIV, public health entities can pilot emerging interventions in real-world settings, and use an implementation science approach to evaluate outcomes and assess the implementation strategies that drive or hinder effectiveness.
在美国，与男性发生性关系的黑人男性（MSM）在艾滋病毒护理连续体方面仍然存在差距。作为卫生资源和服务管理局艾滋病毒/艾滋病局（美国卫生与公众服务部）资助的一项倡议的一部分，我们搜索了最近发表的干预措施，这些措施旨在改善美国艾滋病毒阳性黑人 MSM 的艾滋病毒护理连续体结果。我们的搜索确定了 14 项干预措施，所有这些措施都与至少一个具有统计学意义的结果相关。药物依从性是最常见的关注结果，而与护理的联系则是最不常见的。超过一半的干预措施针对年轻人群，并发生在美国南部。干预措施采用了一系列策略来提高文化相关性，并解决黑人 MSM 实现最佳艾滋病毒结果的常见障碍。一些干预措施利用了社交媒体、短信和智能手机应用程序，以促进社会支持、提供艾滋病毒教育和鼓励药物依从性。干预措施主要在个人或人际层面进行，尽管有三项措施对系统层面进行了改革，以解决结构障碍。值得注意的是，缺乏专注于减少行为健康障碍的干预措施，以及直接解决住房等健康决定因素的干预措施。为了加快实施和扩大针对艾滋病毒阳性黑人 MSM 的干预措施的步伐，公共卫生实体可以在真实环境中试点新出现的干预措施，并采用实施科学方法来评估结果，并评估推动或阻碍有效性的实施策略。
