Comprehensive, tailored, technology-based intervention to improve virologic suppression among youth and young adults living with HIV

全面、量身定制、基于技术的干预措施，以改善艾滋病毒感染者的病毒抑制

基本信息

批准号：
10693334
负责人：
Parya Saberi
金额：
$ 105.62万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-06-30
项目状态：
未结题

项目摘要

Abstract/Project Summary: In the US, youth and young adults living with HIV (YLWH) have lower rates of antiretroviral therapy (ART) initiation, suboptimal ART adherence and retention in care, and higher rates of virologic failure, compared to older age groups. Additionally, there is an increased risk of substance dependence, psychiatric disorders, and mortality with increased risk of substance use at a younger age. Mental health (MH) and substance use (SU) impact every step of the HIV care continuum from diagnosis to viral suppression and exacerbate socioeconomic challenges of linkage and sustained access to healthcare. Given the strong evidence for the influence of MH and SU on poor HIV health outcomes, there is a clear need for increased access to and provision of these services. Despite the need to address these critical barriers to care in YLWH, there is a severe shortage of MH professionals nationwide and a lack of interventions tailored to this age group. In collaboration with the nonprofit AIDS Healthcare Foundation (the largest provider of HIV care) and a Youth Advisory Panel, the proposed study aims to address these barriers in a tailored manner using a differentiated care approach that is “youth-friendly.” Our goal is to test the effect of a tailored technology-based intervention in a randomized clinical trial (RCT) with an adaptive treatment strategy (ATS) among 200 YLWH (18–29 years old). The intervention includes: (1) brief weekly counseling sessions with a counselor to discuss MH, SU, HIV care engagement, and other barriers to care delivered via a video-chat platform, and (2) a mobile health application designed and developed using Human-Centered Design (HCD) with YLWH to address barriers to engagement in care. Individuals who are not virologically suppressed will be randomized to video- counseling+app or standard of care (SOC). Through this entirely remotely-conducted study, we will be able to: Aim 1: Test the efficacy of video-counseling+app vs SOC on virologic suppression in YLWH. We will compare HIV virologic suppression of those randomized to the intervention vs control arms at 16 weeks via an RCT. Aim 2: Assess the impact of video-counseling+app vs SOC on MH and SU in YLWH. We will evaluate the MH and SU differences between the intervention vs control arms at 16 weeks via an RCT. Aim 3: Explore an ATS to individualize the intervention by assigning the: (a) virologic “non-responders” in the intervention arm to intensified video-counseling+app for 16 more weeks, (b) virologic “responders” in the intervention arm to continue only app use for 16 more weeks. Therefore, in an era of severe shortages of MH providers when MH and SU challenges of YLWH are critical barriers to care, examining an innovative intervention developed using HCD with a differentiated care approach directed specifically to YLWH, grounded in a well-established theoretical model of care and formative research, and with community partnership is necessary for “getting to zero” and ending the HIV epidemic.

摘要/项目摘要：在美国，患有艾滋病毒（YLWH）的年轻人和年轻人的抗逆转录病毒疗法率较低（ART）与之相比年龄段的年龄段。此外，存在物质依赖性，精神疾病和死亡率增加，年轻时使用药物的风险。心理健康（MH）和药物使用（SU）影响HIV护理连续体的每个步骤，从诊断到病毒抑制和恶化联系和持续获得医疗保健的社会经济挑战。鉴于有力的证据 MH和SU对不良HIV健康结果的影响，显然需要增加进入和访问提供这些服务。尽管需要解决这些关键的护理障碍，但仍有一个在全国范围内严重缺乏MH专业人员，并且缺乏对该年龄段的干预措施。与非营利组织艾滋病医疗基金会（最大的艾滋病毒护理提供商）合作，青年咨询小组，拟议的研究旨在以量身定制的方式解决这些障碍差异化的护理方法“对青年友好”。我们的目标是测试量身定制的基于技术的效果在200 YLWH中具有自适应治疗策略（ATS）的随机临床试验（RCT）干预（18-29岁）。干预措施包括：（1）与辅导员进行讨论的简短每周咨询会议 MH，SU，HIV护理参与以及通过视频聊天平台提供的其他护理障碍，以及（2）手机使用以人为本的设计（HCD）设计和开发的健康应用程序，以解决参与护理的障碍。在病毒学上未受到抑制的个人将被随机分为视频 - 咨询+应用或护理标准（SOC）。通过这项完全远程导导的研究，我们将能够： AIM 1：测试视频策略+APP与SOC在YLWH中有关病毒抑制的效率。我们将比较 HIV病毒学抑制那些通过RCT在16周后与干预措施随机分配到干预臂的人。 AIM 2：评估视频策略+应用与SOC对MH和SU在YLWH中的影响。我们将评估MH 通过RCT，干预措施与控制臂之间的SU差异。目标3：通过分配以下方式探索ATS来个性化干预措施（a）干预部门中的病毒性“非反应者”，以加强视频会议+应用程序16周，（b）干预部门中的病毒“响应者”仅继续使用App使用16周。因此，在MH和SU的YLWH挑战至关重要时，MH提供商严重短缺的时代至关重要护理的障碍，检查使用HCD采用差异化护理方法开发的创新干预措施专门针对YLWH，以良好的护理和形成性研究的理论模型为基础有了社区伙伴关系，对于“达到零”并结束艾滋病毒流行是必要的。