Dangerfield Ii Derek T, Anderson Janeane N, Wylie Charleen, Arrington-Sanders Renata, Bluthenthal Ricky N, Beyrer Christopher, Farley Jason E
Johns Hopkins School of Nursing, Baltimore, MD, United States.
Us Helping Us, People Into Living, Inc, Washington, DC, United States.
JMIR Form Res. 2022 Aug 10;6(8):e34181. doi: 10.2196/34181.
Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decrease HIV incidence among Black sexual minority men (BSMM). However, BSMM perceive others as PrEP candidates instead of themselves and are less likely than other groups to use PrEP if prescribed. Peers and smartphone apps are popular HIV prevention intervention tools typically used independently. However, they could be useful together in a multicomponent strategy to improve perceived HIV risk and PrEP initiation for this group. Information regarding attitudes and preferences toward this multicomponent strategy is limited.
The goal of this study is to obtain attitudes and perspectives regarding the design of a multicomponent intervention that uses a smartphone app and a peer change agent (PCA) to increase perceived HIV risk and PrEP initiation. The intervention will be refined based on thematic findings for a culturally responsive approach.
Data were obtained guided by life course theory and the health belief model using 12 focus groups and 1 in-depth interview among HIV-negative BSMM from Baltimore, MD, between October 2019 and May 2020 (n=39). Groups were stratified by the following ages: 18 to 24 years, 25 to 34 years, and 35 years and older. Participants were provided details regarding an existing mobile app diary to self-monitor sexual behaviors and a hypothetical PCA with whom to review the app. Facilitators posed questions regarding perceived HIV risk, attitudes toward the app, working with a PCA, and preferences for PCA characteristics and approaches.
Most participants identified as homosexual, gay, or same gender-loving (26/38, 68%), were employed (26/38, 69%), single (25/38, 66%), and interested in self-monitoring sexual behaviors (28/38, 68%). However, themes suggested that participants had low perceived HIV risk, that self-monitoring sexual behaviors using a mobile app diary was feasible but could trigger internalized stigma, and that an acceptable PCA should be a possible self for BSMM to aspire to but they still wanted clinicians to "do their job."
HIV-negative BSMM have dissonant attitudes regarding perceived HIV risk and the utility of a mobile app and PCA to increase perceived HIV risk and PrEP initiation. Future research will explore the feasibility, acceptability, and preliminary impact of implementing the multicomponent intervention on perceived HIV risk and PrEP initiation among BSMM in a pilot study.
需要增加暴露前预防（PrEP）的启动率，以大幅降低黑人性少数男性（BSMM）中的艾滋病毒感染率。然而，BSMM认为其他人是PrEP的适用对象，而不是自己，并且如果被开了PrEP处方，他们使用PrEP的可能性低于其他群体。同伴和智能手机应用程序是常用的艾滋病毒预防干预工具，通常单独使用。然而，在多组分策略中，它们可能会共同发挥作用，以提高该群体对艾滋病毒风险的认知并促进PrEP的启动。关于对这种多组分策略的态度和偏好的信息有限。
本研究的目的是了解关于一种多组分干预措施设计的态度和观点，该干预措施使用智能手机应用程序和同伴改变推动者（PCA）来提高对艾滋病毒风险的认知并促进PrEP的启动。将根据主题研究结果对干预措施进行完善，以采用文化响应式方法。
在2019年10月至2020年5月期间，以生命历程理论和健康信念模型为指导，对来自马里兰州巴尔的摩的艾滋病毒阴性BSMM进行了12个焦点小组讨论和1次深入访谈（n = 39），从而获取数据。小组按以下年龄分层：18至24岁、25至34岁和35岁及以上。向参与者提供了有关用于自我监测性行为的现有移动应用程序日记的详细信息，以及一个用于与他们一起查看该应用程序的假设PCA。主持人提出了关于对艾滋病毒风险的认知、对该应用程序的态度、与PCA合作以及对PCA特征和方法的偏好等问题。
大多数参与者认同自己为同性恋、男同性恋或同性恋爱者（26/38，68%），有工作（26/38，69%），单身（25/38，66%），并且对自我监测性行为感兴趣（28/38，68%）。然而，主题表明参与者对艾滋病毒风险的认知较低，使用移动应用程序日记自我监测性行为是可行的，但可能引发内化的耻辱感，并且一个可接受的PCA应该是BSMM可能想要成为的自我，但他们仍然希望临床医生“做好本职工作”。
艾滋病毒阴性的BSMM在对艾滋病毒风险的认知以及移动应用程序和PCA在提高对艾滋病毒风险的认知和促进PrEP启动方面的效用方面存在不一致的态度。未来的研究将在一项试点研究中探索实施这种多组分干预措施对BSMM中艾滋病毒风险认知和PrEP启动的可行性、可接受性和初步影响。
