Integration of Peer Navigation and mHealth Technology to Improve Viral Suppression among Racial and Ethnic Minority PLWH in Community-Based HIV Care Clinics

整合同伴导航和移动医疗技术，以改善社区艾滋病毒护理诊所中少数族裔艾滋病毒感染者的病毒抑制

• 批准号: 10668374
• 负责人: Eileen Virtusio Pitpitan
• 金额: $ 67.31万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10668374
• 关键词: 2 arm randomized control trial; Address; Adherence; Affect; Behavioral; Black Populations; Caring; Clinic; Clinical; Cocaine; Communities; Community Health Aides; Competence; Continuity of Patient Care; Counseling; Country; County; Data; Developing Countries; Disparity; Epidemic; Equilibrium; Ethnic Origin; Fentanyl; Frequencies; Goals; HIV; HIV Infections; Health; Health Technology; Heroin; Hispanic Populations; Intervention; Mediator; Methamphetamine; Mexico; Modeling; Motivation; Not Hispanic or Latino; Opioid; Outcome; Persons; Pharmaceutical Preparations; Phase; Play; Race; Reporting; Resource-limited setting; Resources; Rest; Role; Self Efficacy; Social Network; Stimulant; Subgroup; Technology; Testing; Training; Viral; Viral Load result; arm; black women; clinical care; clinical effect; cost; design; efficacy evaluation; efficacy testing; ethnic disparity; ethnic minority; follow-up; implementation cost; improved; intervention delivery; mHealth; marginalized population; mobile application; navigator intervention; novel; opioid use; peer; peer support; primary outcome; programs; racial disparity; racial minority; randomized trial; scale up; secondary outcome; skills; social stigma; stimulant use; substance abuse treatment; substance use; syndemic; theories; treatment as usual; treatment disparity; usability; web app

PROJECT SUMMARY Significant disparities continue to exist in the HIV care continuum in the U.S., with Hispanic and Black persons living with HIV (HBPLH) being less likely to achieve viral suppression compared to non-Hispanic White persons living with HIV. The same HIV treatment disparities exist in San Diego County, one of the focal counties under the Ending the HIV Epidemic Initiative. Disparities are exacerbated by co-occurring syndemic conditions, including substance use. Peer navigators, as one type of community health worker, have been shown to play meaningful roles to support PLH to stay engaged in care in developing countries. More rigorous studies are needed to evaluate the impact of peer navigators on the HIV care continuum in the U.S. While peer navigators may promote positive outcomes among PLH, scale-up of the traditional peer navigation approach is difficult in real-world settings where there are limited resources to support peer navigators. Scalable, mHealth intervention approaches are needed to strengthen the impact of peers on the HIV care continuum outcomes among HBPLH. Mobile (m)Health and other technologies offer scalable platforms for intervention delivery through channels (e.g., online, mobile apps, SMS, and social networking platforms) that can overcome limitations and costs of in-person interventions. Combining both peer navigators and mHealth into a unified, scalable intervention could both strengthen the impact of peer navigators on HIV care continuum outcomes among HBPLH, and simultaneously reduce the resources needed to support peer navigators in clinical settings, effectively striking the ideal balance between maximizing clinical effect sizes and lowering peer navigator costs to promote sustainability. Partnering with a community-based clinic (San Ysidro Health, SYH) serving HBPLH under the Ryan White model in South San Diego, we propose a two-arm RCT (n=375) of an mHealth peer navigator intervention called Peers plus mobile App for Treatment in HIV (PATH). We will integrate two theoretically-grounded interventions developed by this team – one with a strong peer navigator component (called “Conexiones Saludables”) and the other with a scalable mHealth component (called “LinkPositively”)– into the PATH intervention, with the goal of amplifying the impact of peer navigators on viral suppression among HBPLH. We will integrate, refine, and usability test (Phase 1) these interventions into a unified, community-informed intervention, PATH, to be rigorously evaluated in a RCT (Phase 2). We will test the efficacy of PATH with 375 HBPLH (among whom >33% will report stimulant and/or opioid use in the past 6 months) to: 1) Improve sustained viral suppression (i.e., suppressed viral load at both 6- and 12-month follow-up) compared to usual care; 2) Examine the theory-informed mediators (e.g., self- efficacy to engage in HIV care, HIV stigma) through which PATH has the greatest impact on sustained viral suppression among HBPLH; and 3) Explore whether PATH significantly affects substance-related outcomes (e.g., frequency of substance use, engagement in substance abuse treatment) when compared to usual care among those using substances (i.e., stimulants and/or opioids).

项目概要 美国的艾滋病毒护理连续性仍然存在显着差异，西班牙裔和黑人 与非西班牙裔白人相比，艾滋病毒感染者 (HBPLH) 实现病毒抑制的可能性较小 艾滋病毒感染者在圣地亚哥县也存在同样的艾滋病毒治疗差异，该县是重点县之一。 终止艾滋病毒流行计划因同时发生的综合症而加剧， 包括药物使用在内的同伴导航者作为社区卫生工作者的一种，已被证明发挥了作用。 正在开展更严格的研究，以支持 PLH 继续从事护理工作。 需要评估同伴导航员对美国艾滋病毒护理连续体的影响。 可能会促进 PLH 取得积极成果，但传统同行导航方法的推广很难 现实环境中支持同行导航器的资源有限。 需要采取一些方法来加强同伴对 HBPLH 中艾滋病毒护理连续结果的影响。 移动 (m) 健康和其他技术为通过渠道（例如， 在线、移动应用程序、短信和社交网络平台），可以克服面对面的限制和成本 将同伴导航器和移动医疗结合成统一的、可扩展的干预措施可以两者兼而有之。 加强同伴导航员对 HBPLH 中艾滋病毒护理连续结果的影响，同时 减少在临床环境中支持同行导航员所需的资源，有效地实现理想的平衡 最大限度地提高临床效果和降低同行导航成本之间的关系，以促进可持续发展。 与南部社区诊所 (San Ysidro Health, SYH) 合作，按照 Ryan White 模式为 HBPLH 提供服务 圣地亚哥，我们提出了一项称为 Peers plus 的 mHealth 同伴导航干预的双臂随机对照试验 (n=375) 我们将整合开发的两种基于理论的干预措施。 由该团队创建 - 一个具有强大的同行导航器组件（称为“Conexiones Saludables”），另一个具有强大的同行导航器组件（称为“Conexiones Saludables”） 可扩展的 mHealth 组件（称为“LinkPositively”）——进入 PATH 干预，目标是扩大 我们将整合、完善和可用性测试同行导航器对 HBPLH 病毒抑制的影响。 （第一阶段）将这些干预措施纳入统一的、社区知情的干预措施 PATH 中，进行严格评估 在 RCT（第 2 阶段）中，我们将测试 PATH 对 375 HBPLH 的功效（其中 >33% 将报告兴奋剂）。 和/或过去 6 个月内使用阿片类药物），以： 1) 改善持续病毒抑制（即，抑制病毒载量） 6 个月和 12 个月的随访）与常规护理相比；2）检查理论指导的中介因素（例如，自我干预） 参与艾滋病毒护理、艾滋病毒耻辱）的 PATH 对持续病毒感染的影响最大 HBPLH 的抑制；3) 探索 PATH 是否显着影响物质相关的结果 （例如，药物使用频率、参与药物滥用治疗）与常规护理相比 那些使用物质（即兴奋剂和/或阿片类药物）的人。