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.

项目概要 新兴成年人和感染艾滋病毒的 18-29 岁青少年 (YLWH) 是所有年龄组中最不可能参与的 护理或实现病毒学抑制，南 YLWH 生活在现代美国艾滋病毒的中心 流行性。在德克萨斯州，艾滋病毒在青少年中快速传播的分子簇凸显了错失的机会 包括护理参与和病毒学抑制方面的延迟，以及我们目标中的 YLWH 低于 20% 德克萨斯州南部的人群实现了病毒学抑制。我们的长期目标是提高病毒学检测率 通过开发一种用于护理参与的新型移动医疗 (mHealth) 工具来抑制 YLWH。 移动医疗干预措施，如智能手机应用程序 (apps)，迅速被年轻人采用，并且是一种 在提高 YLWH 的护理参与度方面资源未得到充分利用。本项目拟进行调整并试点 Dillingham 和 Ingersoll 开发的现有移动医疗工具 PositiveLinks Program (PL) 的功效 （共同）。 Pl 是一种多模式干预，包括每日依从性评估、预约提醒、安全 与诊所提供者的消息传递以及在线匿名同行支持网络。 PL 增加护理 在观察性研究中，艾滋病毒感染者（大多数>40岁）的参与和病毒学抑制尚未得到证实 在YLWH进行了研究。 Taylor (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，YLWH 要求移动医疗方法 订婚。我们将以计划行为理论（TPB）为理论模型，积极青年 开发 (PYD) 作为严格调整和试点测试 PL 修改版本的方法，PositiveLinks 青少年 (PL4Y)。 为此，我们将对 PositiveLinks 进行严格的形成性评估，使其适应 YLWH 的需求， 包括： TPB 与 YLWH 进行的半结构化访谈，其中 YLWH 经历了小心的挑战 参与和利益相关者以及青年咨询委员会的反馈（目标 1）。然后我们将开发并 迭代地调整 PL 的组成部分以及从形成过程中出现的新的以年轻人为中心的组成部分 对新诊断、脱离护理或未使用病毒学抑制的 YLWH 进行评估 由 PYD 提供的以人为本的设计方法，为青年创造 PositiveLinks (PL4Y)（目标 2）。 最后，我们将在 YLWH 中对改编后的 PL4Y 计划进行小型试点随机对照试验 脱离或新近参与艾滋病毒护理，以评估其对病毒学抑制的影响（目标 3）。混合型 方法过程评估将评估这种新颖干预措施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，以满足发展和 YLWH 的社会/结构需求。我们的方法可以作为有效适应移动医疗的模型 针对新的目标受众进行干预，以满足迫切的社区需求。