Medical Mistrust Among Hispanic/Latino Gay, Bisexual and Other Men Who Have Sex With Men (HLMSM)

Study Overview
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Brief Summary
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There is an urgent need to address HIV inequities and disparities in the US, particularly within vulnerable communities such as Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM).

Detailed Description
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Medical mistrust is associated with HIV disparities among HLMSM because mistrust may result in delayed or reduced use of needed HIV prevention (e.g., HIV testing and Pre-exposure prophylaxis (PrEP) uptake) and care (e.g., AntiretroViral Therapy [ART]) services. While advances have been made to increase the use of HIV prevention and care services, profound disparities persist, and a need remains for increased understanding of the multilevel drivers of medical mistrust and for effective interventions to address these drivers among HLMSM in the US. This research proposes a mixed-method study that includes rigorous qualitative and quantitative methods to better understand the drivers of medical mistrust among Spanish-speaking, English-speaking, and bilingual (including Spanish and English, or an indigenous language and Spanish and/or English) HLMSM. This study also proposes to refine and test a multilevel intervention designed to address medical mistrust and increase the use of needed HIV prevention and care services among diverse HLMSM in Mecklenburg County, NC, a jurisdiction prioritized by the Ending the HIV Epidemic in the US (EHE) initiative.

Official Title
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Identifying and Addressing Historical and Structural Drivers of Medical Mistrust Among Hispanic/Latino Gay, Bisexual and Other Men Who Have Sex With Men

Conditions
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Human Immunodeficiency Virus

Intervention / Treatment
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* Behavioral: Navigators (peer navigator) training
* Behavioral: delayed-intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: reside in Mecklenburg County, NC identify as Hispanic/Latino be ≥18 years of age speak English and Spanish report identifying as male and having had sex with at least 1 man in the past 6 months provide informed consent Exclusion Criteria: less than 18 years of age female

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Recruit, enroll, and collect baseline data from 144 Hispanic/Latino Gay, Bisexual and Other Men Who Have Sex With Men (HLMSM), including 16 Community-Based Peer Navigators (known as Navigators) and their social network members (n=8 unique social network members per leader). Navigators (coupled with their social networks) will be randomly assigned to intervention (n=8 Navigators; n=64 social network members) or delayed-intervention (n=8 Navigators; n=64 social network members) groups. Navigators in the intervention group will be trained and supported for 12 months of implementation across years 3 and 4; those in the delayed-intervention group will be trained in year 5
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Navigators (peer navigator) training<br>Training is designed to increase knowledge and skills. Navigators in the intervention group will be trained and supported for 12 months of implementation across years 3 and 4 | Behavioral: Navigators (peer navigator) training<br>* The Navigators training will be designed to increase knowledge and skills to help others (i.e., social network members). Navigators in the intervention group will be trained and supported for 12 months of implementation across years 3 and 4<br>|
| Experimental: delayed-intervention group<br>Training is designed to increase knowledge and skills. The delayed-intervention group will be trained in year 5 | Behavioral: delayed-intervention<br>* Those in the delayed-intervention group will be trained in year 5<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Rate of medical mistrust | The Group-Based Medical Mistrust Scale (GBMMS) - The response key was a Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree) and the score range was 12 to 60 - higher scores indicate greater levels of medical mistrust | baseline to post-intervention up to 18 months | 
| Change in Rate of Human Immunodeficiency Virus (HIV) testing | Change in Rate of Human Immunodeficiency Virus (HIV) testing - Self-Report - did participant use testing in past 12 months | baseline to post-intervention up to 18 months | 
| Change in Rate of pre-exposure prophylaxis (PrEP) uptake | Change in Rate of pre-exposure prophylaxis (PrEP) uptake - did participant use PrEP in past 12 months | baseline to post-intervention up to 18 months | 
| Change in the amount of use of HIV care services | Change in the amount of use of HIV care services - did participant use HIV care in past 12 months | baseline to post-intervention up to 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hispanic/Latino gay, bisexual men, HIV prevention