Improving engagement in care via Community-based mHealth Motivational Interviewing Tool for HIV-positive youth (COMMIT+)

通过基于社区的移动医疗动机访谈工具提高艾滋病毒阳性青少年的护理参与度 (COMMIT)

• 批准号: 9766392
• 负责人: Bibhav Acharya
• 金额: $ 22.64万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-20 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766392
• 关键词: AIDS clinical trial group; Address; Adherence; Adolescent; Adult; Appointment; Asia; Audiotape; Awareness; Behavior; CD4 Lymphocyte Count; Caring; Cause of Death; Client; Clinic; Clinical; Collaborations; Communication; Communities; Community Health Aides; Consent; Continuity of Patient Care; Data Analytics; Development; Disease; Effectiveness of Interventions; Environment; Face; Feasibility Studies; Feedback; Feeling; Freedom; Future; Grant; HIV; HIV Seropositivity; Health; Health Services Accessibility; Human; Incentives; Incidence; India; Individual; Infrastructure; Intervention; Judgment; Link; Logistics; Maintenance; Measures; Methods; Motivation; Nepal; Normalcy; Outcome; Pathway interactions; Persons; Pharmaceutical Preparations; Pharmacy facility; Prevalence; Process; Process Measure; Research; Resistance; Resources; Rural; Rural Population; Sampling; Site; Social Psychology; Specialist; Standardization; Supervision; Testing; Thinking; Training; Transcript; Underserved Population; United States; Viral Load result; Visual; Work; Youth; analog; antiretroviral therapy; arm; base; contextual factors; design; effective intervention; experience; follow-up; handheld mobile device; improved; literacy; mHealth; motivational enhancement therapy; multi-site trial; pilot trial; programs; prototype; recruit; rural area; skills; success; tool; treatment adherence

Project Summary Worldwide, youth living with HIV (YLWH) are poorly engaged in care and have worse health outcomes than adults do. Despite this, there is a lack of effective interventions to improve YLWH's engagement in care: keeping clinic appointment and adhering to antiretroviral therapy. Interventions to address this have largely focused on external motivations, incentives, and environment redesign. However, there is compelling evidence from social psychology that internal, rather than external, motivators are strongly associated with maintenance of positive and healthy behaviors. Motivational Interviewing (MI) has been used around the world to enhance the client's internal motivation to improve care engagement for numerous diseases, including HIV. In parallel, Community Health Workers (CHWs) have demonstrated the capacity to reach vulnerable, rural populations, who are less likely to engage in care. However, a common finding is that MI training without ongoing supervision leads to skill decay, and CHWs return to judgmental advice-giving, which can alienate YLWH. Building on our work over the last ten years in rural Nepal and India, we propose to address these challenges by developing a Community-based mHealth Motivational Interviewing Tool for HIV- positive youth (COMMIT+). COMMIT+ will be used by CHWs to: 1) obtain decision-support to deliver MI for individual cases in the community, and 2) capture consented audio recordings of client interactions for review and feedback by their supervisors so CHWs can maintain MI skills beyond the initial training period. In the proposed study, we will develop, study, and refine COMMIT+ for a future multi-site trial to improve care engagement about YLWH. We will pursue two aims: 1) To develop the Community- based mHealth Motivational Interviewing Tool for HIV-positive youth (COMMIT+) to support community health workers in using and sustaining motivational interviewing skills; and 2) To assess the acceptability and feasibility of COMMIT+ among YLWH, CHWs, and their supervisors to improve adherence to antiretroviral therapy, clinic appointments, and CD4 counts. Using human-centered design thinking, we will iteratively develop COMMIT+ and test it at a site with one of the highest incidence and prevalence of HIV in Nepal, and where CHWs already use mobile devices to assist in clinical tasks. At completion, we expect to have adapted COMMIT+ and demonstrated its acceptability and feasibility among YLWH, CHWs, and their supervisors, and to have prepared an application for a multi-site trial in Nepal and India, where the MPIs have worked for over a decade.

项目概要 在世界范围内，感染艾滋病毒的青少年 (YLWH) 缺乏护理服务，健康状况也较差 结果比成年人还好。尽管如此，仍缺乏有效的干预措施来改善 YLWH 参与护理：保持门诊预约并坚持抗逆转录病毒治疗。干预措施 为了解决这个问题，主要关注外部动机、激励措施和环境重新设计。 然而，社会心理学有令人信服的证据表明，内在的，而不是外在的， 激励因素与维持积极健康的行为密切相关。 动机访谈 (MI) 已在世界各地广泛使用，以增强客户的内部动机 提高对包括艾滋病毒在内的多种疾病的护理参与度的动机。与此同时，社区 卫生工作者 (CHW) 已展现出接触弱势农村人口的能力，他们 参与护理的可能性较小。然而，一个普遍的发现是，没有持续的 MI 培训 监督会导致技能衰退，而社区卫生工作者会回归判断性的建议，这可能会疏远 YLWH。 基于我们过去十年在尼泊尔和印度农村地区所做的工作，我们建议解决这些问题 通过开发基于社区的移动医疗艾滋病毒动机访谈工具来应对挑战 积极的青年（COMMIT+）。 COMMIT+ 将被 CHW 用于：1) 获得决策支持以交付 针对社区个别案例的 MI，以及 2) 捕获客户同意的录音 进行互动以供主管审查和反馈，以便社区卫生工作者能够在超出工作范围的情况下保持 MI 技能 初始训练期。 在拟议的研究中，我们将开发、研究和完善 COMMIT+，以进行未来的多站点试验 提高 YLWH 的护理参与度。我们将追求两个目标：1）发展社区- 基于 mHealth 的 HIV 阳性青少年动机访谈工具 (COMMIT+) 来支持 社区卫生工作者使用和维持动机访谈技巧； 2) 评估 YLWH、CHW 及其主管对 COMMIT+ 的可接受性和可行性，以改进 坚持抗逆转录病毒治疗、门诊预约和 CD4 计数。运用以人为本 设计思维，我们将迭代开发 COMMIT+ 并在具有最高性能之一的站点上对其进行测试 尼泊尔的艾滋病毒发病率和流行率以及社区卫生工作者已经使用移动设备来协助 临床任务。 完成后，我们期望采用 COMMIT+ 并证明其可接受性和 YLWH、CHW 及其主管之间的可行性，并准备一份申请 MPI 已在尼泊尔和印度开展了十多年的多地点试验。