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.

撒哈拉以南非洲地区受艾滋病毒流行影响最严重，特别是赞比亚的年轻人。 HIV (YPWH) 受到 HIV/AIDS 的影响尤为严重，其特点是处于成年初期（18-24 岁）。 通过增强独立性、冒险行为、身份探索和改变社会支持， 可能会影响艾滋病毒管理行为，包括药物依从性、护理保留率、性风险 行为和药物滥用对健康和艾滋病毒相关问题具有协同和累加效应。 合并症，以及针对艾滋病毒和药物滥用的加速艾滋病毒疾病自我管理干预措施。 我们迫切需要减少赞比亚的 YPWH。 移动健康干预促进艾滋病毒自我管理并减少药物使用我们将调整 4-。 会议，针对移动医疗 (mHC) 的面对面健康选择 (HC) 干预，以增加医疗服务的获取和提供 此外，我们还将开发并试点激励短信 (MTM)，以增强激励短信的影响力。 mHC. mHC 和 MTM 将使用我们的计算机干预创作系统 (CIAS) 进行交付。 我们将主要目标是开发和评估由此产生的移动医疗干预措施的初步效果。 利用多阶段优化策略 (MOST) 框架来确定最有效的干预措施 解决 YPWH 自我管理和药物使用问题的组件或组件组合 拟议的研究包括 3 个阶段，包括与赞比亚 YPWH 进行焦点小组合作。 探索和促进艾滋病毒自我管理和物质使用障碍，为干预阶段提供信息。 II 包括使用社区对 mHC 和 MTM 进行功能和可行性的调整和 Beta 测试 赞比亚 YPWH 顾问委员会、当地医护人员和社区领袖 在第三阶段，我们将。 使用 MOST 框架进行试点，以评估可行性、可接受性和初步效果 干预措施（mHC 和 MTM），以改善艾滋病毒自我管理并减少饮酒和其他 一百名 YPWH 被随机分配到四种实验条件：1) 标准 ART 咨询。 (SAC)，2) mHC + SAC，3) MTM + SAC，以及 4) mHC + MTM + SAC 的可行性和可接受性。 干预将通过使用模式的参数数据和系统初步可用性量表进行评估。 将通过评估 ART 依从性来评估影响，YPWH 将在 2019 年完成评估。 基线以及干预后 3 个月和 6 个月的生物标志物将是坚持 ART 和 HIV/STI 的生物标志物。 项目完成后，我们将采用优化的移动医疗干预措施来支持 YPWH 的自我管理。 艾滋病毒管理，将准备在更大规模的疗效试验中进行测试。