LetSync: An mHealth approach to HIV care engagement among black men in couples

LetSync：一种促进黑人夫妇艾滋病毒护理参与的移动医疗方法

基本信息

批准号：
10334358
负责人：
Judy You Rong Tan
金额：
$ 9.99万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-16 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10334358
关键词：
Adherence Age Anti-Retroviral Agents Behavior Bisexual Buffers Caring Cellular Phone Communities Continuity of Patient Care Couples Data Analyses Development Diagnosis Focus Groups Future Gays HIV HIV diagnosis Hair Health Health Technology Healthcare Individual Intervention Interview Joints Knowledge Lead Measures Metadata Outcome Pathway interactions Patient Self-Report Personal Satisfaction Play Population Problem Solving Procedures Process Protocols documentation Public Health Randomized Randomized Controlled Trials Research Resources Sampling Schedule Social support Structure Subgroup Testing Theoretical model Translating Treatment outcome Viremia Waiting Lists Work acceptability and feasibility antiretroviral therapy arm base black men black men who have sex with men care coordination care outcomes coping design efficacy testing efficacy trial improved interest mHealth meetings men who have sex with men mobile computing pilot trial primary outcome protocol development prototype racial disparity resilience secondary outcome skills social structure socioeconomics therapy adherence transmission process

项目摘要

PROJECT SUMMARY/ABSTRACT (Original proposal) Based on current diagnoses rates, one in two Black men-who-have-sex-with-men (BMSM) will be diagnosed with HIV during their lifetime. Interventions to optimize retention in care and adherence to antiretroviral therapy (ART) among BMSM are urgently needed to reduce HIV racial disparities. Dyadic intervention approaches are promising, given that nearly half of BMSM living with HIV are in primary relationships, and are consistent with calls for research with BMSM to focus beyond the individual level. Our preliminary research with BMSM in couples finds that the primary relationship is often the main resource in meeting needs in HIV care engagement. BMSM couples engage in joint problem-solving and dyadic coordination of care that entail synchronizing and co-organizing schedules, activities, and behaviors around treatment and care. We also found that dyadic coordination and joint problem-solving in care engagement may be more common among BMSM couples with greater couple’s resilience, defined as the couple’s capacity to overcome shared adversity that buffers against the strains of social and structural factors on health and wellbeing for BMSM. Based on our preliminary work and extant research, we developed a theoretical Framework of Dyadic HIV Care Engagement to guide this research. Smartphones are ubiquitous among BMSM of various ages and socioeconomic backgrounds, and mobile technology for health (mHealth) is feasible, acceptable, and effective as HIV interventions among BMSM. We have developed initial designs for a BMSM-couple-focused intervention application (app), LetSync, to improve retention in care and ART adherence. BMSM couples showed a great interest in this approach. However, critical issues remain, such as the need for a deeper understanding of how dyadic processes interrelate to bolster dyadic capacity, how they may be targeted in an mHealth intervention, and the need for piloting intervention components and features. As such, the aims to this R01 are as follows. Aim 1 will involve investigating interrelated dyadic processes in HIV care engagement (couple’s resilience, joint problem-solving, dyadic coordination) through in-depth interviews with BMSM in 12 seroconcordant-positive and 12 serodiscordant couples (24 couples, N=48) guided by our conceptual framework. Aim 2 will develop a couple’s mHealth intervention informed by Aim 1 and our prior mHealth designs, through iterative app development with a community advisory council of BMSM couples and a mini-pilot of the app prototype, intervention protocols, and procedures. Aim 3 will entail a randomized, waitlist-controlled pilot trial with 80 couples (N=160) to assess its acceptability, feasibility, and preliminary impact on retention in care and ART adherence as measured by antiretroviral concentrations in hair. Findings from the proposed research are critical for informing a subsequent full-scale RCT to test the efficacy of LetSync in improving HIV care and treatment outcomes among BMSM couples toward reducing HIV racial disparities in the U.S.

项目摘要/摘要（原始提案）根据目前的诊断率，二分之一的男男性行为黑人 (BMSM) 将被诊断出来一生中感染艾滋病毒的干预措施，以优化护理保留和抗逆转录病毒治疗的依从性。 BMSM 中迫切需要减少艾滋病毒种族差异的二元干预方法。鉴于近一半的 BMSM 艾滋病毒感染者处于主要关系中，并且与呼吁 BMSM 的研究重点超越个人层面。夫妇发现主要关系往往是满足艾滋病毒护理需求的主要资源 BMSM 夫妇共同解决问题并进行护理协调。我们还围绕治疗和护理同步和共同组织日程、活动和行为。发现护理参与中的二元协调和联合解决问题可能在护理参与中更为常见 BMSM 夫妻的复原力更强，定义为夫妻克服共同逆境的能力根据我们的数据，可以缓冲社会和结构性因素对 BMSM 健康和福祉的压力。根据前期工作和现有研究，我们制定了二元艾滋病毒护理参与的理论框架智能手机在不同年龄和社会经济的 BMSM 中无处不在。背景，移动健康技术（mHealth）与艾滋病毒一样可行、可接受且有效我们已经开发了以 BMSM 夫妇为重点的干预措施的初步设计。应用程序（应用程序）LetSync 在提高护理保留率和 BMSM 夫妇的依从性方面表现出了很好的效果。然而，关键问题仍然存在，例如需要更深入地了解如何实现。二元过程与增强二元能力相互关联，如何在移动医疗干预中瞄准它们，以及试点干预组件和功能的需求因此，R01 的目标如下。目标 1 将涉及调查艾滋病毒护理参与中相互关联的二元过程（夫妻的复原力、联合通过对 BMSM 的 12 名血清一致阳性患者进行深入访谈，解决问题、二元协调）在我们的概念框架的指导下，12对血清不一致的夫妇（24对，N = 48）将开发一个。通过迭代应用程序，根据目标 1 和我们之前的 mHealth 设计进行夫妇的 mHealth 干预与 BMSM 夫妇组成的社区咨询委员会和应用程序原型的迷你试点一起开发，目标 3 将需要进行一项随机、候补名单控制的试点试验，其中包括 80 名患者。夫妇 (N=160) 评估其可接受性、可行性以及对保留护理和 ART 的初步影响通过头发中的抗逆转录病毒浓度来衡量的依从性是拟议研究的结果。这对于为随后的全面随机对照试验提供信息至关重要，以测试 LetSync 在改善艾滋病毒护理和治疗方面的功效。 BMSM 夫妇的治疗结果有助于减少美国艾滋病毒种族差异