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数字化、众包、多层次干预措施促进男男性行为者的 HIV 检测:集群随机对照试验。

Digital, Crowdsourced, Multilevel Intervention to Promote HIV Testing Among Men Who Have Sex With Men: Cluster Randomized Controlled Trial.

机构信息

Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.

Cheeloo College of Medicine, Shandong University, Jinan, China.

出版信息

J Med Internet Res. 2023 Oct 30;25:e46890. doi: 10.2196/46890.


DOI:10.2196/46890
PMID:37902831
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10644183/
Abstract

BACKGROUND: Despite great efforts in HIV prevention worldwide, HIV testing uptake among men who have sex with men (MSM) remains suboptimal. The effectiveness of digital, crowdsourced, multilevel interventions in improving HIV testing is still unclear. OBJECTIVE: The aim of this study was to evaluate the effect of a digital, crowdsourced, multilevel intervention in improving HIV testing uptake among MSM in China. METHODS: We conducted a 2-arm cluster randomized controlled trial among MSM in 11 cities in Shandong province, China, from August 2019 to April 2020. Participants were men who were HIV seronegative or had unknown serum status, had anal sex with a man in the past 12 months, and had not been tested for HIV in the past 3 months. Participants were recruited through a gay dating app and community-based organizations from preselected cities; these cities were matched into 5 blocks (2 clusters per block) and further randomly assigned (1:1) to receive a digital, crowdsourced, multilevel intervention (intervention arm) or routine intervention (control arm). The digital multilevel intervention was developed through crowdsourced open calls tailored for MSM, consisting of digital intervention images and videos, the strategy of providing HIV self-testing services through digital tools, and peer-moderated discussion within WeChat groups. The primary outcome was self-reported HIV testing uptake in the previous 3 months. An intention-to-treat approach was used to examine the cluster-level effect of the intervention in the 12-month study period using generalized linear mixed models and the individual-level effect using linear mixed models. RESULTS: A total of 935 MSM were enrolled (404 intervention participants and 531 controls); 751 participants (80.3%) completed at least one follow-up survey. Most participants were younger than 30 years (n=601, 64.3%), single (n=681, 72.8%), had a college degree or higher (n=629, 67.3%), and had an HIV testing history (n=785, 84%). Overall, the proportion of testing for HIV in the past 3 months at the 3-, 6-, 9-, and 12-month follow-ups was higher in the intervention arm (139/279, 49.8%; 148/266, 55.6%; 189/263, 71.9%; and 171/266, 64.3%, respectively) than the control arm (183/418, 43.8%; 178/408, 43.6%; 206/403, 51.1%; and 182/397, 48.4%, respectively), with statistically significant differences at the 6-, 9-, and 12-month follow-ups. At the cluster level, the proportion of participants who had tested for HIV increased 11.62% (95% CI 0.74%-22.5%; P=.04) with the intervention. At the individual level, participants in the intervention arm had 69% higher odds for testing for HIV in the past 3 months compared with control participants, but the result was not statistically significant (risk ratio 1.69, 95% CI 0.87-3.27; P=.11). CONCLUSIONS: The intervention effectively improved HIV testing uptake among Chinese MSM. Our findings highlight that digital, crowdsourced, multilevel interventions should be made more widely available for HIV prevention and other public health issues. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900024350; http://www.chictr.org.cn/showproj.aspx?proj=36718. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-04860-8.

摘要

背景:尽管在全球范围内为预防艾滋病病毒做出了巨大努力,但男男性行为者(MSM)的艾滋病病毒检测率仍然不理想。数字、众包、多层次干预措施在提高艾滋病病毒检测率方面的效果尚不清楚。 目的:本研究旨在评估一种数字、众包、多层次干预措施在中国提高 MSM 艾滋病病毒检测率的效果。 方法:我们在 2019 年 8 月至 2020 年 4 月期间在中国山东省的 11 个城市开展了一项 2 组随机对照试验。参与者是 HIV 血清阴性或血清状态未知、过去 12 个月内与男性发生过肛交且过去 3 个月内未接受过 HIV 检测的男性。参与者通过一个同性恋约会应用程序和社区组织从预选城市招募;这些城市被匹配成 5 个块(每个块 2 个集群),并进一步随机分配(1:1)接受数字、众包、多层次干预(干预组)或常规干预(对照组)。数字多层次干预措施是通过针对 MSM 的众包公开呼吁制定的,包括数字干预图像和视频、通过数字工具提供 HIV 自检服务的策略以及微信小组内的同行 moderation 讨论。主要结局是报告的过去 3 个月内接受 HIV 检测的情况。采用意向治疗方法,使用广义线性混合模型在 12 个月的研究期间检查干预对集群水平的效果,使用线性混合模型检查对个体水平的效果。 结果:共有 935 名 MSM 参与(404 名干预参与者和 531 名对照参与者);751 名参与者(80.3%)完成了至少一次随访调查。大多数参与者年龄小于 30 岁(n=601,64.3%)、单身(n=681,72.8%)、具有大学学历或以上(n=629,67.3%)且有 HIV 检测史(n=785,84%)。总体而言,在第 3、6、9 和 12 个月的随访中,干预组在过去 3 个月内接受 HIV 检测的比例(139/279,49.8%;148/266,55.6%;189/263,71.9%;171/266,64.3%)高于对照组(183/418,43.8%;178/408,43.6%;206/403,51.1%;182/397,48.4%),在第 6、9 和 12 个月的随访中差异有统计学意义。在集群水平上,与对照组相比,接受干预的参与者中接受 HIV 检测的比例增加了 11.62%(95% CI 0.74%-22.5%;P=.04)。在个体水平上,与对照组相比,干预组的参与者在过去 3 个月内接受 HIV 检测的可能性高 69%,但结果无统计学意义(风险比 1.69,95% CI 0.87-3.27;P=.11)。 结论:该干预措施有效提高了中国 MSM 的艾滋病病毒检测率。我们的研究结果强调,数字、众包、多层次干预措施应更广泛地应用于艾滋病预防和其他公共卫生问题。 试验注册:中国临床试验注册中心 ChiCTR1900024350;http://www.chictr.org.cn/showproj.aspx?proj=36718。 国际注册报告标识符(IRRID):RR2-10.1186/s13063-020-04860-8。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/7caedf926b26/jmir_v25i1e46890_fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/68a50923872c/jmir_v25i1e46890_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/c23a608ac107/jmir_v25i1e46890_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/96a5012a3b88/jmir_v25i1e46890_fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/5970d3846ada/jmir_v25i1e46890_fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/7caedf926b26/jmir_v25i1e46890_fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/68a50923872c/jmir_v25i1e46890_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/c23a608ac107/jmir_v25i1e46890_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/96a5012a3b88/jmir_v25i1e46890_fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/5970d3846ada/jmir_v25i1e46890_fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc7/10644183/7caedf926b26/jmir_v25i1e46890_fig5.jpg

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本文引用的文献

[1]
A differentiated digital intervention to improve antiretroviral therapy adherence among men who have sex with men living with HIV in China: a randomized controlled trial.

BMC Med. 2022-10-10

[2]
Digital approaches to enhancing community engagement in clinical trials.

NPJ Digit Med. 2022-3-25

[3]
Digital Formats for Community Participation in Health Promotion and Prevention Activities: A Scoping Review.

Front Public Health. 2021

[4]
Community-Based Interventions as Opportunities to Increase HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men - Lessons From Ghana, West Africa.

Front Public Health. 2021

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eHealth Interventions to Address Sexual Health, Substance Use, and Mental Health Among Men Who Have Sex With Men: Systematic Review and Synthesis of Process Evaluations.

J Med Internet Res. 2021-4-23

[6]
Digital crowdsourced intervention to promote HIV testing among MSM in China: study protocol for a cluster randomized controlled trial.

Trials. 2020-11-17

[7]
Impact of providing free HIV self-testing kits on frequency of testing among men who have sex with men and their sexual partners in China: A randomized controlled trial.

PLoS Med. 2020-10-9

[8]
Internet use and need for digital health technology among the elderly: a cross-sectional survey in China.

BMC Public Health. 2020-9-11

[9]
The Enigma of the Human Immunodeficiency Virus (HIV) Epidemic in China.

Clin Infect Dis. 2021-3-1

[10]
The Effectiveness of Electronic Health Interventions for Promoting HIV-Preventive Behaviors Among Men Who Have Sex With Men: Meta-Analysis Based on an Integrative Framework of Design and Implementation Features.

J Med Internet Res. 2020-5-25

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