Adapting mHealth interventions to improve self-management of HIV and substance use among emerging adults in Zambia

采用移动医疗干预措施，改善赞比亚新兴成年人对艾滋病毒和药物滥用的自我管理

• 批准号: 10813460
• 负责人: Karen MacDonell
• 金额: $ 24.74万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10813460
• 关键词: Acceleration; Address; Adherence; Adult; Affect; Africa South of the Sahara; Age; Alcohol consumption; Alcohols; Appointment; Behavior; Behavioral; Biological Markers; Caring; Clinic; Cognitive; Communities; Continuity of Patient Care; Counseling; Development; Disease; Dose; Drug usage; Effectiveness; Epidemic; Evidence based intervention; Focus Groups; Future; HIV; HIV Infections; HIV/AIDS; HIV/STD; Health; Health Personnel; Health behavior; Health system; Healthcare; Infection; Intervention; Interview; Link; Monitor; Motivation; NIH Program Announcements; Outcome; Patient Recruitments; Pattern; Persons; Pharmaceutical Preparations; Phase; Prevalence; Protocols documentation; Randomized; Resource-limited setting; Risk; Risk Behaviors; Risk Taking; Self Management; Services; Social Change; Social support; Substance abuse problem; System; Testing; Text Messaging; Treatment Efficacy; Viral Load result; Woman; Work; World Health Organization; Youth; Zambia; acceptability and feasibility; age group; alcohol and other drug; antiretroviral therapy; binge drinking; comorbidity; computerized; effective intervention; efficacy trial; emerging adult; emerging adulthood; feasibility research; group intervention; improved; innovation; intervention refinement; mHealth; marijuana use; medical appointment; medication compliance; men; mobile computing; motivational enhancement therapy; multi-site trial; multiphase optimization strategy; negative affect; participant retention; pilot test; pilot trial; post intervention; recruit; reduced substance use; response; satisfaction; sexual risk behavior; skills; social stigma; substance use; therapy adherence; therapy design; transmission process; usability

Sub-Saharan Africa is most severely affected by the HIV epidemic, particularly Zambia. Young people with HIV (YPWH) are disproportionately impacted by HIV/AIDS. Emerging adulthood (ages 18-24) is characterized by increasing independence, risk-taking behaviors, identity exploration, and changing social supports, which may impact HIV management behaviors, including medication adherence, retention in care, sexual risk behavior, and substance abuse. Substance use has synergistic and additive effects on health and HIV-related comorbidities, and accelerated HIV disease. Self-management interventions targeting HIV and substance use reduction in Zambian YPWH are urgently needed. We propose to develop and pilot a multi-component, mHealth intervention to promote HIV self-management and reduce substance use. We will adapt the 4- session, in-person Healthy Choices (HC) intervention for mHealth (mHC) to increase access and delivery of HC. In addition, we will develop and pilot test Motivational Text Messaging (MTM) to enhance the impact of mHC. mHC and MTM will be delivered using Computerized Intervention Authoring System (CIAS). Our primary aim is to develop and assess the preliminary efficacy of the resulting mHealth intervention. We will utilize a Multiphase Optimization Strategy (MOST) framework to identify the most effective intervention component or combination of components that addresses self-management and substance use among YPWH in Zambia. The proposed study includes 3 phases. Phase I includes focus groups with Zambian YPWH to explore barriers and facilitators of HIV self-management and substance use to inform the intervention. Phase II consists of adapting and beta testing of mHC and MTM for functionality and feasibility using a community advisory board of Zambian YPWH, local healthcare personnel, and community leaders. In Phase III, we will conduct a pilot using the MOST framework to assess feasibility, acceptability, and preliminary efficacy of intervention components (mHC and MTM) to improve HIV self-management and reduce alcohol and other drug use. One hundred YPWH be randomized to four experimental conditions: 1) Standard ART Counseling (SAC), 2) mHC + SAC, 3) MTM + SAC, and 4) mHC + MTM + SAC. Feasibility and acceptability of the intervention will be assessed through paradata of usage patterns and the System Usability Scale. Preliminary impact will be assessed by evaluating ART Adherence and substance use. YPWH will complete assessments at baseline and 3-, and 6-months post-intervention. Biomarkers of adherence to ART and HIV/STI will be collected. Upon project completion, we will have an optimized mHealth intervention to support YPWH’s self- management of HIV which will be ready for testing in a larger efficacy trial.

撒哈拉以南非洲受艾滋病毒流行，尤其是赞比亚的严重影响。年轻人 艾滋病毒（YPWH）受艾滋病毒/艾滋病的影响不成比例。新兴成年（18-24岁）的特征是 通过提高独立性，冒险行为，身份探索和不断变化的社会支持，这是 可能会影响艾滋病毒管理行为，包括药物依从性，保留护理，性风险 行为和药物滥用。药物使用对健康和HIV相关的协同和添加作用 合并症和加速HIV疾病。针对艾滋病毒和药物使用的自我管理干预措施 迫切需要减少赞比亚YPWH。我们建议开发和驾驶多组分， MHealth干预措施以促进HIV自我管理并减少药物使用。我们将适应4-- 会议，面对面的健康选择（HC）MHealth（MHC）以增加访问和交付 HC。此外，我们将开发和试行测试动机文本消息传递（MTM），以增强 MHC。 MHC和MTM将使用计算机干预创作系统（CIAS）交付。我们的 主要目的是开发和评估由此产生的MHealth干预的初步效率。我们将 利用多相优化策略（大多数）框架来识别最有效的干预措施 解决YPWH中自我管理和物质使用的组件组件或组合 在赞比亚。拟议的研究包括3个阶段。第一阶段包括带有赞比亚YPWH的焦点小组 探索艾滋病毒自我管理和物质使用的障碍和促进者，以告知干预措施。阶段 II包括使用社区的MHC和MTM的适应和Beta测试，用于功能和可行性 赞比亚YPWH，当地医疗保健人员和社区领导者的顾问委员会。在第三阶段，我们将 使用最多的框架进行飞行员，以评估可行性，可接受性和初步效率 干预组件（MHC和MTM）以改善HIV自我管理并减少酒精和其他 吸毒。一百YPWH被随机分配到四个实验条件：1）标准艺术咨询 （SAC），2）MHC + SAC，3）MTM + SAC和4）MHC + MTM + SAC。可行性和可接受性 干预将通过使用模式和系统可用性量表进行评估。初步的 影响将通过评估艺术依从性和物质使用来评估。 YPWH将完成评估 干预后的基线和3个月和6个月。坚持艺术和艾滋病毒/STI的生物标志物将是 集。项目完成后，我们将进行优化的MHealth干预措施，以支持YPWH的自我 艾滋病毒的管理将准备在更大的效率试验中进行测试。