Adaptation and implementation of a behavioral mHealth intervention to reduce anxiety and depression and end the HIV epidemic in the rural South

适应和实施行为移动健康干预措施，以减少焦虑和抑郁并结束南方农村地区的艾滋病毒流行

• 批准号: 10619925
• 负责人: Preeti Manavalan
• 金额: $ 18.28万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-09 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619925
• 关键词: Address; Adopted; Adoption; Affect; Africa South of the Sahara; Anxiety; Award; Behavior Therapy; Behavioral; Caring; Communicable Diseases; Communities; Community Health Aides; Complex; Consolidated Framework for Implementation Research; Consultations; Counseling; Data; Effectiveness; Epidemic; Evaluation; Evidence based intervention; Failure; Florida; Friendships; Goals; HIV; HIV disparities; Health; Health Personnel; Health Services Accessibility; Health Technology; Health system; Hybrids; Individual; Intervention; Investments; Maintenance; Medical; Medicine; Mental Depression; Mental Health; Mental Health Services; Mentored Patient-Oriented Research Career Development Award; Mentorship; Modality; Modeling; Outcome; Persons; Physicians; Population; Program Development; Provider; Qualitative Research; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Proposals; Rural; Rural Population; Science; Scientist; Societal Factors; Specialist; System; Target Populations; Technology; Training; Transportation; Treatment outcome; Underserved Population; Universities; Viral; antiretroviral therapy; anxiety reduction; anxiety symptoms; clinical care; depressive symptoms; design; effective intervention; effectiveness evaluation; effectiveness outcome; effectiveness/implementation study; effectiveness/implementation trial; evidence base; experience; implementation evaluation; implementation intervention; implementation outcomes; implementation science; improved; intervention delivery; mHealth; member; novel; pilot test; problem solving therapy; professor; programs; randomized trial; rural area; rural counties; skills; social; stakeholder perspectives; therapy adherence; trial design; underserved community

ABSTRACT Untreated anxiety and depression are exceedingly common in people living with HIV (PLWH) in the rural South, a population critically affected by the HIV epidemic. Addressing mental health is essential to improving the disparate HIV burden in this population. Yet outside of routine clinical care, few interventions target mental health in PLWH in the rural South. Mobile health technology (mHealth) and community health worker (CHW)- delivered care are two intervention models that address barriers unique to rural, underserved, populations. Dr. Manavalan is an assistant professor in the Division of Infectious Diseases and Global Medicine at the University of Florida. She seeks a K23 award to gain skills, experience and preliminary data needed to become an independent physician-scientist focused on developing and implementing novel and scalable interventions in underserved communities that will contribute to Ending the HIV Epidemic. Through the training and research proposal outlined in this award, Dr. Manavalan will bridge the fields of HIV and mental health by incorporating evidence-based interventions effective in other settings into existing medical systems in Florida. In this 4-year study Dr. Manavalan will adapt an evidence-based CHW-delivered counseling intervention for delivery through an existing mHealth application, as a strategy to reduce anxiety and depression and maximize viral suppression in PLWH in the rural South. In Aim 1, she will conduct robust qualitative research with diverse key stakeholders, guided by the Consolidated Framework for Implementation Research (CFIR), to discern perspectives to inform adaption and implementation of the intervention. Next, in Aim 2, she will assemble a Design Consultation Team composed of 12 members from key stakeholder groups (PLWH from the target population, HIV and mental health providers, and mHealth and behavioral scientists) to assist in adapting CHW- delivered counseling for mHealth delivery, tailored to a rural population. Adaption of the intervention will occur iteratively, be informed from data from Aim 1 and will be guided by the ADAPT-ITT framework. Lastly, in Aim 3, she will pilot the adapted intervention with a type 1 hybrid effectiveness-implementation trial and assess implementation outcomes (reach, adoptability, implementation, maintenance) and preliminary effectiveness outcomes (viral suppression, HIV care retention, ART adherence, and anxiety and depression symptoms) using the RE-AIM model. The proposed program will enable Dr. Manavalan to gain expertise in 1) adaption and evaluation of behavioral interventions, 2) mHealth science, and 3) implementation science and hybrid trial design through mentorship with leading experts, didactic coursework, professional development programs, and application of research. This study will lay the groundwork for a fully powered R01 trial to evaluate implementation and effectiveness of the adapted intervention in underserved communities throughout the state of Florida.

抽象的 Untreated anxiety and depression are exceedingly common in people living with HIV (PLWH) in the rural South, a population critically affected by the HIV epidemic. Addressing mental health is essential to improving the disparate HIV burden in this population.在常规临床护理之外，很少有干预措施针对精神 南部农村的PLWH的健康状况。移动卫生技术（MHealth）和社区卫生工作者（CHW） - 交付的护理是两个干预模型，可解决农村，服务欠缺的人群所特有的障碍。 Manavalan博士是传染病和全球医学部的助理教授 佛罗里达大学。她寻求K23奖，以获得技能，经验和初步数据 独立的医师科学家致力于制定和实施新颖的可扩展干预措施 服务不足的社区将有助于终止艾滋病毒流行。通过培训和研究 该奖项概述的提案，Manavalan博士将通过合并来弥合艾滋病毒和心理健康领域 基于证据的干预措施在其他环境中对佛罗里达州现有医疗系统有效。 在这项为期四年的研究中 通过现有的MHealth应用程序交付，作为减少焦虑和抑郁并最大化的策略 南部农村的PLWH病毒抑制。在AIM 1中，她将与多样化进行强大的定性研究 主要利益相关者在实施研究（CFIR）的合并框架的指导下，辨别 perspectives to inform adaption and implementation of the intervention.接下来，在AIM 2中，她将组装一个 设计咨询团队由主要利益相关者群体的12名成员组成（来自目标的PLWH 人口，艾滋病毒和心理健康提供者以及MHealth和行为科学家）协助改编CHW- 为MHealth交付提供了咨询服务，该咨询是针对农村人口量身定制的。干预的适应 迭代地，请从AIM 1的数据中告知，并将以Autapt-Itt框架为指导。最后，在AIM 3中， 她将通过1型混合有效性试验进行调整的干预措施，并评估 实施成果（触及，可采用，实施，维护）和初步效力 结局（病毒抑制，艾滋病毒护理保留，艺术依从性以及焦虑和抑郁症状）使用 Re-Aim模型。 拟议的计划将使Manavalan博士能够在1）改编和评估中获得专业知识 行为干预，2）MHealth Science和3）实施科学和混合试验设计 与领先专家的指导，教学课程，专业发展计划以及应用 研究。这项研究将为一项全功率的R01试验奠定基础，以评估实施和 对整个佛罗里达州服务不足的社区的改编干预的有效性。