LinkPositively: A Technology-Delivered Peer Navigation and Social Networking Intervention to Improve HIV Care Across the Continuum for Black Women Affected by Interpersonal Violence

LinkPositively：技术提供的同伴导航和社交网络干预措施可改善受人际暴力影响的黑人妇女的艾滋病毒护理

• 批准号: 10064028
• 负责人: Keith Joseph Horvath
• 金额: $ 23.25万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-01 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064028
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Affect; Biological; CD4 Lymphocyte Count; Caring; Clinic; Clinical; Continuity of Patient Care; Coping Skills; Counseling; County; Data; Databases; Diagnosis; Domestic Violence; Feedback; Focus Groups; Friends; Goals; HIV; HIV Seropositivity; HIV diagnosis; Health Services Accessibility; Interpersonal Violence; Intervention; Intervention Studies; Interview; Medical; Mental Health; Modeling; Monitor; Outcome; Outcome Study; Participant; Patient Self-Report; Phase; Preparation; Procedures; Proliferating; Provider; Race; Randomized; Randomized Controlled Trials; Recommendation; Recording of previous events; Reminder Systems; Reporting; Research Project Grants; Resources; Risk; Science; Self Care; Self Efficacy; Services; Sexual abuse; Shelter facility; Social Network; Social support; Spouses; Substance Use Disorder; Substance abuse problem; Suggestion; Technology; Telephone; Testing; Text; Time; Trauma; Triad Acrylic Resin; Viral; Visit; Visual; Woman; Youth; acceptability and feasibility; antiretroviral therapy; arm; black women; care outcomes; emotional abuse; experience; follow-up; implementation cost; improved; informant; intervention effect; intimate partner violence; mHealth; male; marginalized population; men who have sex with men; mobile computing; peer; peer networks; peer support; perpetrators; physical abuse; primary outcome; response; service organization; service providers; skills; smartphone Application; social; social stigma; social structure; standard of care; substance use; theories; therapy adherence; usability; violence exposure; virtual

PROJECT SUMMARY In the US, Black women living with HIV/AIDS (WLHA) are less likely to be engaged in care, adherent to antiretroviral therapy (ART), and virally suppressed compared to White WLHA. Concurrently, Black women are also disproportionately affected by interpersonal violence – physical, sexual, and/or psychological abuse by a current or former intimate partner or non-intimate partner – which may co-occur with poor mental health and/or substance use disorders, further contributing to ART non-adherence, lower CD4 counts, and reduced viral suppression. Peer Navigation, while highlighted as a successful model of care in improving HIV care outcomes, requires resources that HIV service agencies often lack. A scalable and sustainable solution is the use of mobile health (mHealth) smartphone applications (“apps”). Although there has been an increase in mHealth interventions developed for HIV prevention and care among at-risk and HIV-positive MSM and youth, we are unaware of any to improve retention in care, ART adherence, and viral suppression among Black WLHA, nor any mHealth interventions that are responsive to Black women’s experiences with interpersonal violence. To address this gap, we will develop and pilot test a culturally tailored, trauma-informed smartphone app, called LinkPositively, for Black WLHA affected by interpersonal violence. Core components of LinkPositively include: a) Virtual Peer Navigation that includes phone and text check-ins and 4 weekly one-on- one video sessions to build skills to cope with barriers and navigate care; b) Social Networking platform to receive peer support; c) Educational and Self-care database with healthy living and self-care tips; d) GPS- enabled Resource Locator for HIV care and ancillary support service agencies; and e) ART self-monitoring and reminder system. Guided by the Theory of Triadic Influences and Syndemic Theory, the study will be conducted in 2 phases with corresponding aims. In Aim 1, 4 focus groups with Black WLHA with experiences of interpersonal violence, one focus group with peer navigators, and 4-6 key informant interviews with providers will be conducted to determine which app features, content, and functions are most likely to support downloading, initiating use, and sustaining engagement over time. Aim 1 will culminate in usability testing by Black WLHA affected by interpersonal violence (n=5), to finalize intervention components and procedures. In Aim 2, we will pilot test LinkPositively to assess feasibility and acceptability and determine preliminary effects of the intervention on HIV care outcomes (i.e., retention in care, ART adherence, viral suppression) and mechanism of change variables (i.e., social support, self-efficacy). Participants will be randomly assigned to either the intervention (n=40) or control (Ryan White standard of care, n=40) arm, with follow-up at 3- and 6- months. This study will benefit the advancement of HIV prevention science by harnessing technology to promote engagement in HIV care, while improving social support through peers and social networking – all under the auspices of being trauma-informed for Black WLHA with experiences of interpersonal violence.

项目概要 在美国，感染艾滋病毒/艾滋病 (WLHA) 的黑人女性不太可能接受护理、坚持接受治疗 与白人 WLHA 相比，黑人女性同时接受抗逆转录病毒治疗 (ART) 和病毒抑制。 也不成比例地受到人际暴力的影响——身体、性和/或心理虐待 现任或前任亲密伴侣或非亲密伴侣——这可能与心理健康状况不佳和/或 物质使用障碍，进一步导致 ART 不依从性、CD4 计数降低和病毒减少 同行导航，同时被强调为改善艾滋病毒护理的成功护理模式。 艾滋病毒服务机构往往缺乏可扩展且可持续的解决方案。 移动健康 (mHealth) 智能手机应用程序（“应用程序”）的使用有所增加。 为高危人群和艾滋病毒阳性男男性行为者和青少年的艾滋病毒预防和护理而制定的移动医疗干预措施， 我们不知道有任何方法可以改善黑人的护理保留率、抗逆转录病毒治疗依从性和病毒抑制能力 WLHA，也没有任何针对黑人女性人际交往经历的移动医疗干预措施 为了解决这一差距，我们将开发并试点测试一款根据文化定制、了解创伤的智能手机。 应用程序，称为 LinkPositively，适用于受人际暴力影响的 Black WLHA。 链接积极包括：a) 虚拟同行导航，包括电话和短信签到以及每周 4 次的一对一交流 一次视频会议，培养应对障碍和指导护理的技能 b) 社交网络平台 获得同伴支持； c) 包含健康生活和自我护理技巧的教育和自我护理数据库 d) GPS- 为艾滋病毒护理和辅助支持服务机构启用资源定位器；以及 e) ART 自我监测和 本研究以三元影响理论和流行病理论为指导。 分 2 个阶段进行，目标 1：与具有经验的黑人 WLHA 进行 4 个焦点小组。 人际暴力、一个由同伴导航员组成的焦点小组以及 4-6 名关键知情人访谈 提供商将确定哪些应用程序特性、内容和功能最有可能支持 下载、开始使用并随着时间的推移持续参与，目标 1 将通过可用性测试达到高潮。 受人际暴力影响的黑人 WLHA（n=5），最终确定干预措施和程序。 目标2，我们将试点LinkPositively，评估可行性和可接受性，并确定初步效果 对 HIV 护理结果的干预措施（即保留护理、ART 依从性、病毒抑制）以及 改变变量的机制（即社会支持、自我效能）。 干预组 (n=40) 或对照组（Ryan White 标准护理组，n=40），并在 3- 和 6- 进行随访 这项研究将通过利用技术来促进艾滋病毒预防科学的进步。 促进艾滋病毒护理的参与，同时通过同伴和社交网络改善社会支持——所有这些 在为具有人际暴力经历的黑人 WLHA 提供创伤信息的赞助下。