PositiveLinks for Youth and Emerging Adults (PL4Y): Adapting a multimodal evidence-based mHealth intervention to increase engagement in HIV care in the Southern US

PositiveLinks for Youth and Emerging Adults (PL4Y)：采用多模式循证移动医疗干预措施以提高美国南部艾滋病毒护理的参与度

• 批准号: 10092223
• 负责人: Barbara S Taylor
• 金额: $ 23.35万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092223
• 关键词: AIDS/HIV problem; Adherence; Administrator; Adolescent; Adopted; Adult; Appointment; Behavior; Behavior Therapy; Caring; Catchment Area; Clinic; Communities; Continuity of Patient Care; Data; Development; Diagnosis; Elements; Epidemic; Evaluation; Feedback; Felis catus; Funding; Geography; Goals; Grant; HIV; Health; Health Personnel; Human; Information Technology; Intervention; Interview; Knowledge; Latinx; Methods; Modeling; Modernization; Molecular; Newly Diagnosed; Observational Study; Outcome; Patients; Persons; Planning Theory; Primary Health Care; Process; Provider; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Research; Research Personnel; Resources; Risk; Secure; Site; South Texas; Structure; Support Groups; Target Populations; Testing; Texas; Text; Theoretical model; Travel; Viral; Visit; Vulnerable Populations; Youth; acceptability and feasibility; age group; barrier to care; base; control trial; design; efficacy testing; emerging adult; evidence base; experience; formative assessment; improved; innovation; mHealth; multi-component intervention; multimodality; new technology; novel; peer support; positive youth development; programs; response; smartphone Application; social health determinants; social stigma; social structure; support network; tool; transmission process; treatment as usual; virology; young adult

Project Summary Emerging adults and youth living with HIV 18-29yo (YLWH) are the least likely of any age group to engage in care or achieve virologic suppression, and Southern YLWH live at the epicenter of the modern U.S. HIV epidemic. In Texas, molecular clusters of rapid HIV transmission among youth highlight missed opportunities including delays in care engagement and virologic suppression, and less than 20% of YLWH in our target population in South Texas achieve virologic suppression. Our long-term goal is to improve rates of virologic suppression for YLWH through development of a novel mobile health (mHealth) tool for care engagement. mHealth interventions, such as smartphone applications (apps), are rapidly adopted by youth, and are an underutilized resource in increasing care engagement for YLWH. This project proposes to adapt and pilot test the efficacy of an existing mHealth tool, the PositiveLinks Program (PL), developed by Dillingham and Ingersoll (Co-Is). Pl is a multimodal intervention, including daily adherence assessment, appointment reminders, secure messaging with clinic providers, and an online anonymized peer support network. PL increased care engagement and virologic suppression in adults (majority >40yo) with HIV in observational studies, but has not been studied in YLWH. Formative research by Taylor (PI), Nijhawan (Co-I), and Villarreal (Co-I) showed that patients and providers in Texas seek relational interventions and YLWH request mHealth approaches for engagement. We will use the Theory of Planned Behavior (TPB) as a theoretical model and Positive Youth Development (PYD) as an approach to rigorously adapt and pilot test a modified version of PL, PositiveLinks for Youth (PL4Y). To do so, we will conduct a rigorous formative evaluation of PositiveLinks to adapt it to the needs of YLWH, including: semi-structured interviews informed by TPB with YLWH experiencing challenges with care engagement and stakeholders, and feedback from a Youth Advisory Board (Aim 1). We will then develop and iteratively adapt components of PL and new youth-focused components emerging from the formative evaluation with YLWH who are newly diagnosed, disengaged in care, or not virologically suppressed using a human-centered design approach informed by PYD to generate PositiveLinks for Youth (PL4Y) (Aim 2). Finally, we will conduct a small pilot randomized control trial of the adapted PL4Y program in YLWH disengaged from or newly engaging in HIV care to assess its impact on virologic suppression (Aim 3). A mixed methods process evaluation will assess acceptability and feasibility of this novel intervention. Through these aims we will develop an innovative care engagement tool that caters to the developmental and socio/structural needs of YLWH. Our approach can serve as a model for efficient adaptation of mHealth interventions to new target audiences in response to an urgent community need.

项目摘要 艾滋病毒18-29岁（YLWH）的新兴成年人和青年在任何年龄段的人中最不可能参与 照顾或实现病毒学抑制，而南部的YLWH居住在现代美国艾滋病毒的中心 流行性。在德克萨斯州，青年中快速艾滋病毒传播的分子簇突出显示了错过的机会 包括护理参与和病毒学抑制的延迟，以及我们目标中不到20％的YLWH 德克萨斯州南部的人口可实现病毒抑制。我们的长期目标是提高病毒学率 通过开发一种新型移动健康（MHealth）工具来抑制YLWH。 MHealth干预措施，例如智能手机应用程序（应用程序），被青年迅速采用，是一个 未充分利用资源来增加对YLWH的护理参与度。该项目建议适应和试点测试 由Dillingham和Ingersoll开发的现有MHealth工具的功效，Potitivelinks计划（PL） （共同）。 PL是一种多模式的干预措施，包括每日依从性评估，任命提醒，安全 与诊所提供商的消息传递以及在线匿名同行支持网络。 PL增加了护理 在观察性研究中，成年人（多数> 40yO）的参与和病毒学抑制，但尚未 在YLWH中进行了研究。泰勒（PI），Nijhawan（Co-​​I）和Villarreal（Co-I）的形成性研究表明 德克萨斯州的患者和提供者寻求关系干预措施，而YLWH请求MHealth方法 订婚。我们将将计划行为的理论（TPB）作为理论模型和积极的青年 开发（PYD）是一种严格适应和试点测试的方法 适用于青年（PL4Y）。 为此，我们将对Potitivelink进行严格的形成性评估，以适应YLWH的需求， 包括：TPB告知的半结构化访谈，YLWH会谨慎面临挑战 参与和利益相关者以及青年顾问委员会的反馈（AIM 1）。然后，我们将发展和 迭代地适应PL的组件和新的以青年为中心的新组件 与新近诊断，脱离护理或不使用病毒学抑制的YLWH评估 PYD告知以人为中心的设计方法为青年生成Potitivelinks（PL4Y）（AIM 2）。 最后，我们将对YLWH的改编PL4Y程序进行小型飞行员随机控制试验 脱离或新参与艾滋病毒护理以评估其对病毒学抑制的影响（AIM 3）。混合 方法评估方法将评估这种新干预的可接受性和可行性。 通过这些目标，我们将开发一种创新的护理参与工具，以迎合发展和 YLWH的社会/结构需求。我们的方法可以作为有效适应MHealth的模型 响应紧急社区需求的新目标受众的干预措施。