A mobile phone intervention using a relational human talking Avatar to promote multiple stages of the HIV Care Continuum in African American MSM

使用关系型人类说话头像进行手机干预，以促进非裔美国 MSM 的艾滋病毒护理连续体的多个阶段

• 批准号: 10318520
• 负责人: Mark S Dworkin
• 金额: $ 74.24万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-11 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10318520
• 关键词: Adherence; Affect; Age; Anti-Retroviral Agents; Appointment; Awareness; Behavior; Behavioral; Car Phone; Caregivers; Caring; Case Manager; Chicago; Cities; Clinic; Collaborations; Continuity of Patient Care; Control Groups; Data; Development; Disease; Empathy; Failure; Feedback; Female; Focus Groups; Food Safety; Frequencies; Funding; HIV; HIV Infections; HIV Seropositivity; Health; Hearing; Home; Human; Individual; Intervention; Knowledge; Measures; Medical center; Mississippi; Modeling; Motivation; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Prevention Research; Privacy; Privatization; Public Health; Randomized; Randomized Controlled Clinical Trials; Risk; Self Efficacy; Source; Telephone; Testing; Therapeutic; United States National Institutes of Health; Universities; Viral; Viral Load result; Work; antiretroviral therapy; attentional control; base; black men who have sex with men; care providers; clinical care; efficacy testing; follow-up; health literacy; improved; improved outcome; infection rate; innovation; intervention participants; literacy; medication compliance; men; men who have sex with men; mortality; phrases; response; scale up; skills; social stigma; theories; therapy adherence; transmission process; treatment research; wireless sensor

ABSTRACT: HIV-positive African American men who have sex with men (AAMSM) have the lowest percentage of retention in care and are less likely to have viral suppression, an outcome that relies on antiretroviral therapy (ART) adherence. This proposal focuses on an innovative theory-driven intervention aimed at helping to improve outcomes for AAMSM targeting 3 stages of the HIV Care Continuum, (1) retention, (2) adherence to antiretroviral medication, and (3) viral suppression. My Personal Health Guide is an innovative talking relational human Avatar mobile phone application to engage HIV-positive AAMSM in adherence and retention in care. Development of this app was informed by the Information Motivation Behavioral Skills Model that focuses on feedback between information and motivation that affect one's behavioral skills, behaviors, and desired health outcomes. In the privacy of the user's home or anywhere they have their phone, the Avatar can encourage healthy behavior, acknowledge stigma and speak with empathy, audibly teach persons with low literacy, employ credible culturally appropriate phrasing, and invite the user to hear advice and motivational stories of other HIV-positive people and their caregivers. A pilot study in HIV- positive AAMSM ages 18-34 years demonstrated acceptability, enthusiasm for the app, and preliminary efficacy. As part of a collaboration between UIC, Emory University, and the University of Mississippi Medical Center, we propose to test the efficacy of the My Personal Health Guide Avatar application for young HIV- positive AAMSM. In this 5-year study, the application will be refined based on pilot data (Aim 1) and then 250 HIV-positive AAMSM between the ages of 18-34 years with detectable viral load at baseline will be randomized to the My Personal Health Guide Avatar application or a food safety Avatar application control intervention for a 6-month period (Aim 2). Wirelessly monitored ART adherence will be collected for 1-month at baseline and then wirelessly monitored ART adherence, viral load, and clinic appointment data will be collected throughout the 6-month follow-up period. We hypothesize that participants in the My Personal Health Guide intervention will demonstrate significant improvements in ART adherence, viral load, and retention in care during the follow- up period compared to control participants. We will also identify mobile phone application functions that are associated with improvement in adherence in order to inform refinement of the application (Aim 3). We hypothesize that more frequent use of Avatar information functions that included motivational messages will be associated with improved ART adherence. This proposal is innovative in that it launches a new direction in prevention and treatment research for young AAMSM, a population at increased risk for therapeutic failure and poor retention in care, by using a relational talking human Avatar in a mobile phone to overcome the impact of stigma and literacy on engagement with clinical care. If the My Personal Health Guide intervention is demonstrated to be effective, it may be quickly scaled up for wide-scale dissemination.

摘要： 与男性发生性关系的艾滋病毒呈阳性的非裔美国男性 (AAMSM) 的感染率最低 保留护理的百分比并且不太可能受到病毒抑制，这一结果依赖于 抗逆转录病毒治疗（ART）依从性。该提案侧重于创新理论驱动的干预 旨在帮助改善 AAMSM 的成果，目标是 HIV 护理连续体的 3 个阶段：(1) 保留、 (2) 坚持抗逆转录病毒药物治疗，以及 (3) 病毒抑制。我的个人健康指南是 创新的会说话的关系型人类阿凡达手机应用程序，让艾滋病毒呈阳性的 AAMSM 参与进来 护理的坚持和保留。这个应用程序的开发是基于信息动机 行为技能模型，重点关注影响个人行为的信息和动机之间的反馈 行为技能、行为和期望的健康结果。在用户家中或他们的任何地方的隐私中 有了手机，阿凡达就可以鼓励健康的行为，承认耻辱并以同理心说话， 对识字率低的人进行有声教学，采用可信的、适合文化的措辞，并邀请用户 听取其他艾滋病毒阳性者及其护理人员的建议和励志故事。一项针对艾滋病毒的试点研究 年龄 18-34 岁的积极 AAMSM 表现出对该应用程序的可接受性和热情，并且初步 功效。作为 UIC、埃默里大学和密西西比大学医学院合作的一部分 中心，我们建议测试“我的个人健康指南阿凡达”应用程序对年轻艾滋病毒患者的功效- 积极的 AAMSM。在这项为期 5 年的研究中，应用程序将根据试点数据（目标 1）进行细化，然后 250 年龄在 18-34 岁之间、基线时可检测到病毒载量的 HIV 阳性 AAMSM 将被随机分组 我的个人健康指南 Avatar 应用程序或食品安全 Avatar 应用程序控制干预 6 个月期限（目标 2）。将收集 1 个月的基线无线监测 ART 依从性， 然后将在整个过程中收集无线监测的 ART 依从性、病毒载量和诊所预约数据 6个月的随访期。我们假设“我的个人健康指南”干预的参与者 将在后续过程中展示 ART 依从性、病毒载量和护理保留率的显着改善 与对照组参与者相比，上升期。我们还将确定手机应用程序的功能 与依从性的提高相关，以便为应用的改进提供信息（目标 3）。我们 假设更频繁地使用包含激励信息的阿凡达信息功能将 与改善 ART 依从性相关。该提案的创新之处在于它开辟了新的方向 针对年轻 AAMSM 的预防和治疗研究，该人群治疗失败的风险较高，并且 通过在手机中使用有关系的会说话的人类头像来克服护理保留率低的影响 参与临床护理的耻辱和素养。如果我的个人健康指南干预是 一旦证明有效，可以迅速扩大规模，进行广泛传播。