Abstract
Comprehensive High Impact Prevention (CHIP) services have reduced new HIV infections in major HIV
epicenters, but many CHIP goals have not been met. A fundamental limitation is the failure to test 90% of at
risk persons. HIV testing is critical to the success of CHIP. Currently, the HIV testing system fails to reach
segments of the men-who-have-sex-with men (MSM) population. Moreover, because CHIP is costly to sustain,
expansion of the current venue-based testing system (i.e., clinical & non-clinical sites) poses a financial burden
for departments of public health (DPHs) with limited budgets. Further, HIV testing costs increase as HIV
prevalence decreases. Consequently, DPHs in urban areas with lower HIV prevalence face an additional
financial burden. Lower prevalence areas are important because they account for a large proportion of new
HIV infections. Identifying cost-efficient methods to increase HIV testing in these communities is key to
reducing the spread of HIV. The proposed R34 will conduct formative research to develop a low-cost
dissemination intervention designed to increase the uptake of HIV testing in an urban community (Portland,
Oregon) with a large MSM population and lower HIV prevalence. Using a community-engaged approach, we
will develop a culturally sensitive intervention to increase the uptake of no-cost Oral-Self-Implemented HIV
testing (Oral-SIT) and facilitate Oral-SIT distribution. Guided by the Push-Pull Infrastructure Model (PPIM), we
will develop intervention core components related to the Push and Infrastructure factors of the PPIM: 1) an
Information-Motivation (IM) component (Push factor) to inform and motivate uptake and correct use of Oral-
SIT; and 2) a Distribution-network component to build community-based infrastructure by organizing a network
(i.e., local DPH, LGBTQ businesses & associated cultural events) to distribute Oral-SIT kits (Infrastructure
factor). We will conduct a formative test of the intervention over a period of six months (i.e., deliver the IM
component, distribute 3000 Oral-SIT kits). Process evaluations at mid-point and the end of the formative
intervention (e.g., focus groups, street intercepts) will assess intervention awareness, acceptability,
implementation feasibility, and potential sustainability, and, specific to the IM component, potential reach. We
will assess Oral-SIT uptake over the course of the intervention (weekly). Lastly, we will develop and evaluate a
supplemental component to the local public health surveillance system that may be used to document new HIV
infections that occur as a function of increased Oral-SIT use. Overall, the results of this study will provide
critical information for the construction and evaluation of a clinical trial of a multi-component dissemination
intervention in lower prevalence cities that will identify new HIV cases and link them to care (R01).
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