Tough Talks: A Disclosure Intervention for HIV+ YMSM

艰难的谈话：针对 HIV YMSM 的披露干预措施

• 批准号: 9348065
• 负责人: Margo Adams Larsen
• 金额: $ 53.07万
• 依托单位: VIRTUALLY BETTER, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9348065
• 关键词: Adherence; Adolescent; Anti-Retroviral Agents; Anus; Artificial Intelligence; Behavior; Caring; Clinic; Complex; Computer software; Continuity of Patient Care; Development; Disclosure; Environment; Exercise; Family; Fright; Funding; Goals; HIV; HIV Infections; HIV Seropositivity; Human Resources; Human immunodeficiency virus test; Incidence; Individual; Intervention; Lead; Location; Mediation; Mental Health; Nature; Newly Diagnosed; Outcome; Participant; Performance; Persons; Phase; Play; Prevention; Process; Randomized Controlled Trials; Reporting; Research; Risk; Role; Services; Sexual Partners; Site; Small Business Innovation Research Grant; Social Network; System; Technology; Testing; Time; United States; United States National Institutes of Health; Viral Load result; Work; Youth; aged; arm; base; condoms; cost; cost effective; eHealth; effectiveness trial; experience; follow-up; improved; innovative technologies; mathematical model; medication compliance; member; men who have sex with men; natural language; primary outcome; programs; response; scale up; sex; social stigma; standard of care; systematic review; technology development; therapeutic development; tool; transmission process; virtual; virtual reality; young men who have sex with men

PROJECT SUMMARY Men who have sex with men (MSM) account for nearly two-thirds all of new HIV infections in the United States (US) and young MSM (YMSM) are the only risk group experiencing a significant increase in HIV incidence. Among youth, 67 percent report not disclosing to their first time sex partners.4 Disclosing of one’s HIV status is important for accessing support which can lead to improved medication adherence and retention in care. Those who disclose are more likely to use condoms with uninfected sex partners5 and mathematical modeling estimates that increased HIV status disclosure to sex partners may reduce transmissions by 40-60%.6,7 Further, disclosure may motivate uninfected sex partners to seek testing and reduce their own HIV transmission behaviors. Given the potential benefits and challenges associated with disclosure, there is a need for sophisticated interventions that can assist MSM, with the disclosure process. Virtual reality provides a unique environment for users to practice HIV disclosure. Artificial intelligence (AI) driven disclosure may offer advantages over in-person role play through the use of realistic avatars that represent potential romantic partners, and probabilistic settings where users envision having disclosure conversations. Users have the opportunity to practice disclosing and experience a variety of responses and outcomes. During Phase I of this project we developed an iPad based virtual reality system that features three avatars, two virtual locations and three disclosure scenarios which represent a variety of common disclosure experiences and contexts experienced by YMSM. In Phase II we will further enhance Tough Talks and develop a full-feature automated version to test via a multi-site, randomized controlled trial (RCT) through the newly created Center for Innovative Technologies (iTech) across the Prevention and Care Continuum, an NIH-funded center to support adolescent HIV research. The aims of this Phase II SBIR are: 1) Refine and enhance the current Tough Talks disclosure scenarios to include additional content, characters and virtual environments. Formative work with YMSM (aged 16-29 years) will inform development and we will work with a leader in AI software to incorporate natural language into the AI driven scenarios; 2) Develop the Tough Talks stand-alone intervention. This fully automated intervention will include the AI driven disclosure scenarios created in aim 1 as well as a virtual disclosure coach to guide participants through the intervention goal-setting interactive exercises and interactive educational videos. Following development, a technical pilot to optimize functionality and technical performance will be conducted with 8-10 YMSM and; 3) Conduct a three-arm combined efficacy/effectiveness trial to compare the intervention delivered online (Arm 1) versus in the clinic (Arm 2) compared to standard of care (SOC) disclosure messaging only. Primary outcomes of HIV viral load and condomless anal intercourse (CAI) will be assessed at intervention completion (1 month) and at 6-month follow-up. We will estimate transmissions averted and program costs of each arm (Months 19-36).

项目概要 美国新感染艾滋病毒的近三分之二是男男性行为者 (MSM) （美国）和年轻的男男性行为者（YMSM）是唯一艾滋病毒发病率显着增加的危险群体。 在青少年中，67% 的人表示不会向他们的第一次性伴侣透露自己的艾滋病毒状况。4 披露自己的艾滋病毒感染状况是 对于获得支持非常重要，这可以提高药物依从性和护理保留率。 那些披露信息的人更有可能与未受感染的性伴侣一起使用安全套5和数学模型 据估计，增加向性伴侣披露艾滋病毒状况可能会减少 40-60% 的传播。6,7 此外，披露可能会促使未感染的性伴侣寻求检测并减少自己的艾滋病毒感染率 考虑到与披露相关的潜在好处和挑战，有必要。 对于可以帮助 MSM 的复杂干预措施，虚拟现实提供了一个披露过程。 人工智能 (AI) 驱动的披露可为用户提供独特的环境。 通过使用代表潜在浪漫的现实化身，比面对面的角色扮演有优势 合作伙伴，以及用户设想进行披露对话的概率设置。 在第一阶段，有机会练习披露并体验各种反应和结果。 在该项目中，我们开发了一个基于 iPad 的虚拟现实系统，该系统具有三个化身、两个虚拟位置和 代表各种常见披露经验和背景的三种披露场景 在第二阶段，我们将进一步增强 Tough Talks 并开发全功能自动化。 该版本将通过新成立的中心进行多中心随机对照试验 (RCT) 进行测试 预防和护理连续体的创新技术 (iTech)，这是一个由 NIH 资助的中心，旨在支持 第二阶段 SBIR 的目标是： 1) 完善和加强当前的艰难对话。 披露场景包括额外的内容、角色和虚拟环境。 YMSM（16-29 岁）将为开发提供信息，我们将与人工智能软件领域的领导者合作，将 将自然语言引入人工智能驱动的场景；2）开发 Tough Talks 独立干预。 自动干预将包括目标 1 中创建的人工智能驱动场景披露以及虚拟 披露教练指导参与者通过干预、目标设定、互动练习和互动 开发后的教育视频，用于优化功能和技术的技术试点。 绩效将通过 8-10 YMSM 进行；3) 进行三臂联合功效/效果评估 试验比较在线（第 1 组）与诊所（第 2 组）提供的干预措施以及标准 护理 (SOC) 仅披露 HIV 病毒载量和无套肛交的主要结果。 (CAI) 将在干预完成（1 个月）和 6 个月的随访时进行评估。 避免的传输和每个臂的计划成本（第 19-36 个月）。