Zapata Juan Pablo, Swann Gregory, Zamantakis Alithia, Madkins Krystal, Danielson Elizabeth Caitlin Anne, Mustanski Brian
Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
AIDS Behav. 2025 May;29(5):1479-1491. doi: 10.1007/s10461-025-04619-9. Epub 2025 Jan 27.
Young men who have sex with men (YMSM) have high rates of substance use, which increases their risk for HIV. Digital Health Interventions (DHI) have the potential to address HIV risk overall and reduce harms in the context of substance use. However, there is limited research on how YMSM with different substance use patterns respond to HIV DHIs and how these programs impact participant outcomes. In this study, we used latent class analysis (LCA) to identify subgroups of participants with specific substance use behaviors in the Keep It Up! (KIU! ) program, an HIV DHI with prior documented effectiveness. This study involved 2,124 participants in a Type III Hybrid trial, comparing two implementation strategies: one via 22 community-based organizations and another through direct-to-consumer recruitment. Evaluations were done at baseline and 12-week follow-up. This analysis identified four classes of substance use: Low Use (minimal alcohol risks, low illicit drug use, infrequent marijuana), Heavy Use (highest alcohol problems, frequent marijuana, elevated illicit drug use), Alcohol and Marijuana Use (high alcohol problems, frequent marijuana), and Methamphetamine and GBH Use (low alcohol risk, moderate marijuana frequency, high illicit drug use). Participants in the Meth & GHB User class were more likely to have an STI at baseline compared to those in the Low User class. Moreover, Heavy Use, Alcohol & Marijuana Use, and Meth & GHB Use reported a greater number of condomless anal sex partners compared to Low Use. Additionally, although Alcohol & Marijuana Use were more likely to use PrEP at the time of their most recent casual partner at baseline, they exhibited the smallest increase in PrEP use during follow-up compared to the other substance use classes. Our analysis did not unveil substantial differences in the success of implementation in terms of reach, suggesting that both implementation strategies effectively engaged YMSM with different levels of substance use. Our research showed a similar level of engagement, as evidenced by the completion rates of modules and time spent, across all substance use classes. However, those within the Meth & GHB category found the intervention highly acceptable, but less so compared to Low Use and Alcohol & Marijuana Use. Understanding how distinct substance use profiles influence intervention outcomes and exploring varied implementation methods can augment future prevention endeavors, broadening the scope and impact of public health initiatives.
与男性发生性行为的年轻男性（YMSM）物质使用发生率较高，这增加了他们感染艾滋病毒的风险。数字健康干预措施（DHI）有可能全面应对艾滋病毒风险，并在物质使用的背景下减少危害。然而，关于具有不同物质使用模式的YMSM如何应对艾滋病毒数字健康干预措施以及这些项目如何影响参与者的结果，相关研究有限。在本研究中，我们使用潜在类别分析（LCA）来确定在“坚持下去！”（KIU!）项目中具有特定物质使用行为的参与者亚组，KIU!是一个先前有记录显示有效的艾滋病毒数字健康干预项目。本研究涉及一项III型混合试验中的2124名参与者，比较了两种实施策略：一种通过22个社区组织，另一种通过直接面向消费者招募。在基线和12周随访时进行评估。该分析确定了四类物质使用情况：低使用（酒精风险最小、非法药物使用少、大麻使用不频繁）、大量使用（酒精问题最严重、频繁使用大麻、非法药物使用增加）、酒精和大麻使用（酒精问题严重、频繁使用大麻）以及甲基苯丙胺和γ-羟基丁酸使用（酒精风险低、大麻使用频率中等、非法药物使用高）。与低使用类别中的参与者相比，甲基苯丙胺和γ-羟基丁酸使用者类别中的参与者在基线时更有可能感染性传播感染。此外，与低使用相比，大量使用、酒精和大麻使用以及甲基苯丙胺和γ-羟基丁酸使用报告的无保护肛交性伴侣数量更多。此外，尽管酒精和大麻使用者在基线时与最近的临时伴侣发生性行为时更有可能使用暴露前预防药物（PrEP），但与其他物质使用类别相比，他们在随访期间PrEP使用的增加幅度最小。我们的分析没有揭示在覆盖范围方面实施成功的实质性差异，这表明两种实施策略都有效地让不同物质使用水平的YMSM参与进来。我们的研究表明，所有物质使用类别在参与程度上相似，这从模块完成率和花费的时间可以看出。然而，甲基苯丙胺和γ-羟基丁酸类别中的人认为该干预措施非常可接受，但与低使用和酒精及大麻使用相比，接受程度较低。了解不同的物质使用情况如何影响干预结果并探索不同的实施方法，可以加强未来的预防工作，扩大公共卫生举措的范围和影响。
