Integration of Trusted Adult Supports into the HealthMpowerment App to Improve Black Adolescent and Young Adult PrEP Use

将值得信赖的成人支持整合到 HealthMpowerment 应用程序中，以改善黑人青少年和年轻成人 PrEP 的使用

• 批准号: 10610486
• 负责人: Samantha V Hill
• 金额: $ 19.13万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610486
• 关键词: 21 year old; AIDS prevention; Address; Adherence; Adolescent Medicine; Adolescent and Young Adult; Adult; Affect; Age; Alabama; Attitude; Award; Behavior Therapy; Behavioral; Behavioral Sciences; Bisexual; Black Populations; Black race; Clinical; Clinical Trials; Collaborations; Communication; Communities; Data; Deep South; Development; Disease; Disparity; Dose; Electronics; Eligibility Determination; Ensure; Epidemic; Ethics; Foundations; Funding; Future; Gays; Geography; Goals; HIV; HIV Infections; HIV diagnosis; Health; Health behavior; Healthcare; Heterosexuals; Human Resources; Incidence; Individual; Infection; Intervention; Interview; K-Series Research Career Programs; Knowledge; Mentors; Mentorship; Methods; Mobile Health Application; Modification; Names; National Institute of Drug Abuse; Oral; Outcome; Parents; Patient Self-Report; Persons; Physicians; Pilot Projects; Population; Positioning Attribute; Process; Provider; Publishing; Regimen; Reproductive Health; Research; Risk; Rural; Rural Community; Schedule; Self Efficacy; Services; Sexual Health; Social Environment; Social Network; Social support; Support System; Surveys; Technology; Training; Trust; United States; United States Dept. of Health and Human Services; United States National Institutes of Health; Visit; Vulnerable Populations; Work; acceptability and feasibility; adherence rate; behavior change; behavioral health intervention; black men who have sex with men; career; community building; community partnership; design; disparity reduction; education resources; empowerment; experience; experimental study; girls; health disparity; improved; instrument; interest; mHealth; male; patient oriented; pediatric human immunodeficiency virus; pill; pre-exposure prophylaxis; prevent; risk perception; rural area; rural counties; sex; skill acquisition; skills; social cognitive theory; social norm; social stigma; success; tool; transgender men; transgender women; urban area; virtual; vulnerable adolescent; young woman

Through lived experiences and my position as an adolescent medicine physician, I have witnessed the lifelong consequences that disparities in health outcomes impose on vulnerable adolescents and young adults (AYAs). This has fueled my long-term goal of developing interventions that empower AYAs, providers, and adults who support AYA acquisition of skills that positively impact all aspects of sexual health, including HIV prevention. Pre-exposure prophylaxis (PrEP) for HIV, a daily or intermittently dosed oral pill, has been shown to be a highly effective biomedical tool for preventing HIV infection. However, the benefits of PrEP have not been experienced equally among all populations with HIV acquisition risk. In particular, PrEP use and adherence rates are low among Blacks, especially Black adolescents and young adults (AYAs), which may explain the disproportionate rates of HIV in many Black communities. Although there are many barriers to PrEP use and adherence among Blacks, including low perception of risk; challenges adhering to a pill regimen and visit schedule; and HIV- and sex-related stigma, few solutions have been shown to improve PrEP use in this population, especially among Black AYAs. An intervention that increases PrEP adherence may be of particular importance for Black AYAs in the Deep South, particularly in states such as Alabama, which has been named a geographic hotspot in the Department of Health and Human Service’s Ending the HIV Epidemic 10-year plan. Grounded in Social Cognitive Theory, and building on previously published data, this proposed study will integrate AYA-trusted adult social support dyadic communication with an existing mobile Health (mHealth) app–the HealthMpowerment app–to facilitate increased PrEP use and adherence among Black AYAs in the Deep South. As more than half of new HIV infections in Alabama occur in rural communities, we will collaborate with community partners within urban and rural areas and create two community advisory boards, one with Black AYAs and one with adults providing support to Black AYAs, to ensure this app fits the needs of urban and rural Black AYAs. Specifically, this multi- methods study will use qualitative interviews and discrete choice experiment surveys to identify 1) trusted adults Black AYAs would ideally partner with, 2) what information trusted adult supports would need to support Black AYAs in PrEP adherence, and 3) app features that Black AYAs and their trusted adult supports feel would best support dyadic communication around AYA PrEP use. After adaptation, the app will be piloted by Black AYAs 14 to 21 years old to inform an application for R34 funding of a larger pilot study. If validated in future clinical trials, this intervention could prove helpful in alleviating disparities in HIV incidence. In addition to providing a tailored health intervention, the comprehensive experiential training, expert mentorship and advising, and critical didactic coursework embodied in this rigorous proposal will build on my clinical expertise and strong background building community partnerships and provide the additional skills I need to become a leader in the development of health behavior interventions focused on reducing disparities in sexual and reproductive health outcomes.

通过现场经验和我作为青少年医学医师的地位，我目睹了终身 健康结果差异对脆弱的青少年和年轻人（AYAS）施加的后果。 这加剧了我的长期目标，即制定干预措施，以增强AYA，提供者和成年人的能力 支持AYA对技能的获取，从而积极影响性健康的各个方面，包括预防艾滋病毒。 暴露前预防（PREP）HIV是每日或间歇性剂量的口服药丸，已被证明是高度 有效预防HIV感染的生物医学工具。但是，准备的好处尚未得到体验 同样，在所有患有艾滋病毒收购风险的人群中。特别是，预备使用和依从性较低 在黑人中，尤其是黑人青少年和年轻人（AYA）中，这可能解释了不成比例的 许多黑人社区的艾滋病毒率。虽然有很多障碍可以使用和依从性 黑人，包括对风险的低认识；遵守药丸方案并访问时间表的挑战；和艾滋病毒和 与性别相关的污名，很少有解决方案可以改善该人群的准备使用，尤其是在 黑色ayas。提高准备依从性的干预措施对于黑色AYA可能特别重要 深南方，特别是在阿拉巴马州等州，该州被任命为地理热点 卫生与公共服务部结束了艾滋病毒流行10年计划。基于社会认知 理论，并在先前发布的数据上，这项拟议的研究将整合受AYA信任的成人社会 支持与现有移动健康（MHealth）应用程序（HealthMpowerment App）的二元沟通 促进南部深处黑色AYA的预备使用和依从性的增加。作为新的一半以上 阿拉巴马州的艾滋病毒感染发生在农村社区，我们将与城市中的社区合作伙伴合作 和粗糙的地区，建立了两个社区咨询委员会，一个是黑色AYA，一个与成年人一起提供 支持黑色AYA，以确保该应用适合城市和粗糙的黑色AYA的需求。具体来说，这个多 方法研究将使用定性访谈和离散选择实验调查来识别1）可信赖的成年人 黑色AYAS理想情况下将与2）支持黑色支持需要哪些信息的成人支持 AYA的准备依从性，以及3）黑色AYA及其可信赖的成人支持的应用程序最佳 支持围绕AYA准备使用的二元沟通。改编后，该应用将被黑色AYA驾驶 14至21岁，以告知申请R34对大型试点研究的资助。如果将来在临床上得到验证 试验，这种干预可能证明有助于减轻HIV事件中的差异。除了提供 量身定制的健康干预措施，全面的专家培训，专家精神和咨询以及关键 这项严格的建议中体现的教学课程将以我的临床专业知识和强大的背景为基础 建立社区伙伴关系，并提供成为发展领导者所需的其他技能 健康行为干预措施的重点是减少性和再现的健康结果的差异。