Schrode Katrina M, Edwards Gabriel G, Moghanian Brandon, Weiss Robert E, Reback Cathy J, McWells Charles, Hilliard Charles L, Harawa Nina T
Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
AIDS Behav. 2025 Jul 10. doi: 10.1007/s10461-025-04818-4.
HIV disproportionately impacts minoritized individuals, particularly those of intersectional minoritized identities. Incarceration disproportionately impacts minoritized individuals as well, and increases HIV risk, in part due to its disruption to people's lives, social networks, and access to care. We developed MEPS, a 6-month intervention designed to holistically support HIV prevention in men who have sex with men and transgender women leaving incarceration. We tested MEPS in a 1:1 randomized controlled trial with 208 individuals. All participants received a needs assessment and personalized wellness plan, followed by either standard of care or the MEPS intervention. MEPS integrated support from a Peer Mentor, incentives for engagement in social and health services, and a mobile app. Participants completed baseline assessments and follow-up assessments at 3, 6, and 9 months. We tested for changes in PrEP use using a group-based trajectory model, for changes in HIV and STI testing, frequent substance use and recidivism using logistic mixed models, and for changes in HCV testing and in having a regular place for care using Poisson models. MEPS participants were significantly more likely than control participants to be among those who used PrEP [AOR (95% CI) = 3.8 (1.8, 8.0)]. Recent HIV testing in the MEPS arm remained above 50% over time while decreasing in the control arm, with a significant difference between arms at 6 months [AOR (95% CI) = 3.5 (1.3, 9.5)]. There were no significant differences between arms in the other outcomes. The MEPS intervention was effective in increasing PrEP uptake and HIV testing in people leaving incarceration. Interventions that implement peer mentor support and incentives to encourage service engagement can improve engagement in HIV prevention services among populations that experience unique barriers to care. This study was registered with ClinicalTrials.gov on July 25, 2019 (NCT04036396).
艾滋病毒对少数族裔个体的影响尤为严重，特别是那些具有交叉少数族裔身份的人。监禁对少数族裔个体的影响也尤为严重，并增加了感染艾滋病毒的风险，部分原因是它扰乱了人们的生活、社交网络以及获得护理的机会。我们开发了MEPS，这是一项为期6个月的干预措施，旨在全面支持男男性行为者和刚出狱的跨性别女性预防艾滋病毒。我们在一项针对208人的1:1随机对照试验中对MEPS进行了测试。所有参与者都接受了需求评估和个性化健康计划，随后接受标准护理或MEPS干预。MEPS整合了同伴导师的支持、参与社会和健康服务的激励措施以及一款移动应用程序。参与者在基线时以及在3个月、6个月和9个月时完成了评估。我们使用基于群体的轨迹模型测试了暴露前预防（PrEP）使用情况的变化，使用逻辑混合模型测试了艾滋病毒和性传播感染检测、频繁使用毒品和再次犯罪情况的变化，使用泊松模型测试了丙型肝炎病毒检测情况以及是否有固定护理场所的变化。与对照组参与者相比，MEPS参与者使用PrEP的可能性显著更高 [优势比（95%置信区间）= 3.8（1.8，8.0）]。随着时间的推移，MEPS组近期的艾滋病毒检测率一直保持在50%以上，而对照组则在下降，两组在6个月时存在显著差异 [优势比（95%置信区间）= 3.5（1.3，9.5）]。在其他结果方面，两组之间没有显著差异。MEPS干预措施在提高刚出狱人群的PrEP使用率和艾滋病毒检测率方面是有效的。实施同伴导师支持和激励措施以鼓励参与服务的干预措施，可以改善在获得护理方面面临独特障碍的人群对艾滋病毒预防服务的参与度。本研究于2019年7月25日在ClinicalTrials.gov上注册（NCT04036396）。
