This proposal, """"""""Improving racial/ethnic minority participation in online HIV prevention research"""""""", addresses the broad Challenge Area (02): Bioethics, and the specific challenge topic 02- OD(OSP)-102*: Ethical Issues in Health Disparities and Access to Participation in Research. Abstract Men who have sex with men (MSM) are the most heavily impacted risk group in the US HIV epidemic, both in absolute numbers and in infection rates. Within the US MSM HIV epidemic, black and Hispanic MSM are disproportionately affected compared to other racial/ethnic groups. Although some internet-based HIV prevention interventions have shown preliminary promise, black and Hispanic MSM are consistently and substantially underrepresented in nearly every major internet-based HIV prevention study reported to date. Thus, there is a need for development of improved methods to increase access to participation in internet-based HIV prevention studies for MSM of color. We propose to conduct a mixed-methods approach to increasing participation of black MSM in internet-based HIV prevention studies. In Phase I, we will conduct focus groups with black MSM about barriers to enrollment in internet studies. In Phase II, we will develop and test banner advertisements for recruitment of MSM to an internet study, based on focus group results In Phase III, we will test factors which may relate to black and Hispanic MSM's recruitment to an internet-based HIV prevention study by varying a number factors relating to design and exposure of online recruitment advertisements (such race of models depicted in the advertisements, age, rural versus urban residence, age, education, sexual identity, degree of gay identity of advertisement, and other factors identified by qualitative data);we will calculate click-through rates for black and Hispanic MSM versus other MSM across combinations of these factors. Once black, Hispanic, and white MSM click through to the study, we will enroll 1,000 MSM (of whom roughly one third each will be black non- Hispanic MSM, Hispanic MSM, and white non-Hispanic MSM) in a longitudinal internet preparedness study, to include at-home HIV testing with a commercially available at-home HIV test kit at baseline and at 12 months. Because we know that there are differences in access of MSM of color to private, high-speed internet, the longitudinal study will randomize men to complete interim collections of behavioral data through either an internet survey at 6 months, or through brief monthly text messaging surveys. The purpose of the longitudinal study is to demonstrate feasibility of collection of biological specimens and of prospective followup in an HIV prevention research study including black and Hispanic MSM, and to determine whether text messaging for follow-up data collection is associated with differential retention. Expected outcomes are recommended best practices for increasing recruitment of black and Hispanic MSM to internet-based HIV prevention trials, and experience with collection of biological specimens for trial endpoints and capacity for retention in such trials.
MSM, especially MSM of color, are the most heavily impacted risk group in the US HIV epidemic, but only 10% of the available best-evidence HIV prevention interventions have been tested with HIV- negative MSM, and MSM of color have been underrepresented in internet-based prevention research. Our project proposes to develop methods that will facilitate recruitment and retention of MSM of color in the rigorous evaluation of online HIV prevention interventions.
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