Development and testing of a mobile application to enhance HIV prevention cascade in Malaysian MSM

开发和测试移动应用程序，以加强马来西亚男男性接触者的艾滋病毒预防级联

• 批准号: 10064800
• 负责人: Roman Shrestha
• 金额: $ 0.87万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-11 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064800
• 关键词: AIDS prevention; Achievement; Acquired Immunodeficiency Syndrome; Address; Adherence; Alcohol or Other Drugs use; Amphetamines; Asia; Benchmarking; Caring; Cellular Phone; Client; Clinic; Communication; Counseling; Country; Decision Making; Development; Discrimination; Drug usage; Epidemic; Face; Focus Groups; Fright; Guide prevention; HIV; HIV Infections; Health; Health Personnel; Health Professional; Health Services; Health Technology; Healthcare; Homosexuality; Human immunodeficiency virus test; Hybrids; Incidence; Income; Institution; Intervention; Interview; Laws; Learning; Link; Malaysia; Malaysian; Measures; Mental Depression; Mental Health; Mental disorders; Modeling; Motivation; Muslim population group; Outcome; Patients; Persons; Phase; Population; Prevalence; Prevention; Preventive Intervention; Provider; Psyche structure; Psychotic Disorders; Readiness; Research; Research Personnel; Risk; Risk Behaviors; Services; Sexual Health; Sexual Transmission; Sexuality; Sexually Transmitted Diseases; Statutes and Laws; Stigmatization; Strategic Planning; Study models; Substance Use Disorder; Suicide; Technology; Testing; Translating; Universities; Unsafe Sex; Ursidae Family; base; care systems; clinical care; comorbidity; cost effective; depressive symptoms; design; efficacy testing; evidence base; health care delivery; health disparity; health management; high risk; implementation science; improved; innovation; insight; interest; low and middle-income countries; mHealth; men; men who have sex with men; mobile application; mortality; overtreatment; pre-exposure prophylaxis; preference; prevention service; prospective test; prototype; research and development; response; scale up; screening; sex; social stigma; southeast Asian; stimulant use; treatment as usual; uptake; usability; virtual

Abstract Malaysia’s HIV epidemic is rapidly expanding with recent evidence suggesting accelerated sexual transmission, especially in MSM: 10% in 2008 to 54% in 2016. Evidence suggests high HIV prevalence in MSM being nationally (21.6%) and in Kuala Lumpur (43%). Central to this expanding HIV epidemic in MSM is condomless sex, STIs, and co-occurring psychiatric and substance use disorders (P/SUD), especially depression and amphetamine-type stimulant (ATS) use. Insights into Malaysia’s HIV prevention gap are multi-factorial. Both homosexuality and substance use is criminalized in Malaysia, making MSM bear the dual burden of stigma and discrimination, including in healthcare, which promotes P/SUD disparities in MSM. MSM are often hesitant to disclose their sexuality, risk behaviors or depressive symptoms, mostly due to fear of stigma, discrimination, or criminalization. Stigma and discrimination are also enacted on MSM by healthcare providers resulting in extraordinary health disparities and low prevention uptake. Strategies that facilitate screening and prevention practices in a non-judgmental fashion are likely to increase access to evidence-based prevention like HIV testing and pre-exposure prophylaxis (PrEP), especially if screening and counseling addresses P/SUD. Introducing an innovative app-based platform to deliver holistic HIV prevention services represents a paradigm shift in HIV prevention since it can deliver effective prevention in a confidential, less-stigmatizing and convenient manner. Building on the advantages for scalability and dissemination afforded using app platform, we propose to develop and test the efficacy of a clinic-affiliated app (myCareLink) to deliver an integrated HIV prevention intervention that will promote HIV testing and linkage to PrEP and incorporates screening and support for underlying P/SUD in Malaysian MSM. The design of this study will take place in 2 phases. The R21 phase will consist of 2 stages: 1) We will adapt, expand and refine an existing app, which will be integrated within the existing clinical care system. First, we will conduct focus groups with MSM (n=25) and stakeholders (n=10) to theater test the existing app to develop an interactive prototype of the myCareLink app (alpha version). Then, the prototype will undergo usability testing (n=20), followed by the full development of the app (beta version); 2) Expanded Beta testing (n=50) of the myCareLink app will assess its usability and acceptability. The R33 phase will involve conducting a Type 1 Hybrid Implementation Science Trial to evaluate the efficacy of myCareLink app vs. treatment as usual (TAU) in 268 Malaysian MSM for primary (HIV testing and PrEP uptake) and secondary (PrEP adherence and persistence) efficacy outcomes. Multi-level implementation outcomes will involve stakeholders’ perspective of the relative advantage of myCareLink app over TAU, adaptability, perceived design quality and packaging, compatibility in the Malaysian context, interest in sharing the app with others and readiness for implementation. Research capacity strengthening between Yale and the University of Malaya will occur through collaborative learning between researchers at both institutions to promote expansion of mHealth research.

抽象的 马来西亚的艾滋病毒流行正在迅速扩大，最近有证据表明加速性行为 传播，特别是在MSM中：2008年10％，2016年的54％。证据表明MSM的HIV患病率很高 在全国（21.6％）和吉隆坡（43％）。 MSM中这种不断扩展的HIV流行的核心是 无避孕套性，性传播疾病和共同发生的精神病和物质使用障碍（p/sud），尤其是抑郁症 和苯丙胺型兴奋剂（ATS）使用。对马来西亚的艾滋病毒预防差距的见解是多因素的。 同性恋和使用物质在马来西亚都被定为犯罪，使MSM遭受了污名的双重燃烧 和歧视，包括在医疗保健中促进MSM中的P/SUD差异。 MSM通常很犹豫 披露他们的性行为，风险行为或抑郁症状，主要是由于害怕污名，歧视， 或定罪。医疗保健提供者还对MSM颁布了污名和歧视，导致 特殊的健康差异和预防吸收低。促进筛查和预防的策略 以非判断性方式的实践可能会增加获得基于证据的预防的机会，例如HIV测试 和暴露前预防（PREP），尤其是在筛查和咨询涉及P/SUD时。介绍一个 基于创新的应用程序的平台提供整体艾滋病毒预防服务代表艾滋病毒的范式转变 预防，因为它可以以机密，污名化和方便的方式提供有效的预防。 在使用应用程序平台提供的可伸缩性和传播优势的基础上，我们建议开发 并测试诊所附属应用程序（Mycarelink）提供综合艾滋病毒预防干预措施的效率 这将促进艾滋病毒测试和联系以进行准备，并纳入对基础P/SUD的筛查和支持 在马来西亚MSM中。这项研究的设计将分为两个阶段。 R21阶段将包括2个阶段：1） 我们将适应，扩展和完善现有应用程序，该应用将集成到现有的临床护理系统中。 首先，我们将与MSM（n = 25）和利益相关者（n = 10）进行焦点小组，以测试现有应用程序 开发Mycarelink应用程序（Alpha版本）的交互式原型。然后，原型将经历 可用性测试（n = 20），然后全面开发应用程序（beta版本）； 2）扩展Beta测试 （n = 50）Mycarelink应用程序将评估其可用性和可接受性。 R33阶段将涉及进行 1型混合实施科学试验，以评估Mycarelink应用程序的效率与往常 （tau）在268个马来西亚MSM中用于主要（HIV测试和摄取）和次要（准备依从性和 持久性的效率结果。多级实施成果将涉及利益相关者的观点 Mycarelink应用程序的相对优势比Tau，适应性，可感知的设计质量和包装， 马来西亚环境中的兼容性，有兴趣与他人共享该应用程序以及准备实施。 耶鲁大学和马来亚大学之间的研究能力将通过合作进行 在两个机构的研究人员之间学习，以促进MHealth研究的扩展。