Integration of Peer Navigation and mHealth Technology to Improve Viral Suppression among Racial and Ethnic Minority PLWH in Community-Based HIV Care Clinics

项目摘要 在美国，艾滋病毒护理连续体继续存在重大差异，西班牙裔和黑人 与非西班牙裔白色人相比，HIV感染者（HBPLH）实现病毒抑制的可能性较小 艾滋病毒携带者同样的艾滋病毒治疗差异存在于圣地亚哥县， 终止艾滋病毒流行倡议。同时发生的综合性疾病加剧了这种差异， 包括药物使用。同伴导航员作为社区卫生工作者的一种， 发挥有意义的作用，支持发展中国家的艾滋病毒携带者继续从事护理工作。更严格的研究是 需要评估同伴导航员对美国艾滋病毒护理连续体的影响。 可能会促进PLH之间的积极成果，传统的同行导航方法的规模扩大是困难的， 现实世界的设置，其中有有限的资源来支持对等导航器。可扩展的移动健康干预 需要采取措施加强同龄人对高血压携带者艾滋病毒护理连续性结果的影响。 移动的（m）保健和其他技术为通过各种渠道（例如， 在线、移动的应用程序、短信和社交网络平台），可以克服面对面的限制和成本 干预措施。将同伴导航器和移动健康结合到一个统一的、可扩展的干预措施中， 加强同伴导航员对HBPLH中艾滋病毒护理连续性结果的影响，同时 减少在临床环境中支持同行导航员所需的资源，有效地达到理想的平衡 在最大化临床效应大小和降低同行导航成本以促进可持续性之间。合作 在南部的Ryan白色模式下，一家以社区为基础的诊所（圣伊西德罗健康中心，SYH）为HBPLH提供服务。 圣地亚哥，我们提出了一个双臂随机对照试验（n=375）的mHealth同行导航干预称为同行加 移动的艾滋病治疗应用程序（PATH）。我们将整合两个理论基础的干预措施， 由这个团队-一个具有强大的同行导航器组件（称为“Conexiones Saludables”），另一个具有 一个可扩展的mHealth组件（称为“LinkPositively”）-纳入PATH干预措施，目的是扩大 同伴导航对HBPLH中病毒抑制的影响。我们将整合、改进和可用性测试 （第1阶段）将这些干预措施合并为一个统一的、社区知情的干预措施，即“适宜卫生技术”，并对其进行严格评估 RCT（第2阶段）。我们将用375例HBPLH（其中>33%报告兴奋剂）来测试PATH的疗效 和/或在过去6个月内使用阿片类药物）以：1）改善持续的病毒抑制（即，抑制的病毒载量. 6个月和12个月随访）与常规护理相比; 2）检查理论告知的中介（例如，表示“自” 艾滋病毒治疗的有效性，艾滋病毒的耻辱感），通过这种途径对持续的病毒感染产生最大的影响。 HBPLH中的抑制;和3）探索PATH是否显著影响物质相关的结果 (e.g.,药物使用频率，参与药物滥用治疗）与常规护理相比 在那些使用物质的人中（即，兴奋剂和/或阿片样物质）。

PROJECT SUMMARY Significant disparities continue to exist in the HIV care continuum in the U.S., with Hispanic and Black persons living with HIV (HBPLH) being less likely to achieve viral suppression compared to non-Hispanic White persons living with HIV. The same HIV treatment disparities exist in San Diego County, one of the focal counties under the Ending the HIV Epidemic Initiative. Disparities are exacerbated by co-occurring syndemic conditions, including substance use. Peer navigators, as one type of community health worker, have been shown to play meaningful roles to support PLH to stay engaged in care in developing countries. More rigorous studies are needed to evaluate the impact of peer navigators on the HIV care continuum in the U.S. While peer navigators may promote positive outcomes among PLH, scale-up of the traditional peer navigation approach is difficult in real-world settings where there are limited resources to support peer navigators. Scalable, mHealth intervention approaches are needed to strengthen the impact of peers on the HIV care continuum outcomes among HBPLH. Mobile (m)Health and other technologies offer scalable platforms for intervention delivery through channels (e.g., online, mobile apps, SMS, and social networking platforms) that can overcome limitations and costs of in-person interventions. Combining both peer navigators and mHealth into a unified, scalable intervention could both strengthen the impact of peer navigators on HIV care continuum outcomes among HBPLH, and simultaneously reduce the resources needed to support peer navigators in clinical settings, effectively striking the ideal balance between maximizing clinical effect sizes and lowering peer navigator costs to promote sustainability. Partnering with a community-based clinic (San Ysidro Health, SYH) serving HBPLH under the Ryan White model in South San Diego, we propose a two-arm RCT (n=375) of an mHealth peer navigator intervention called Peers plus mobile App for Treatment in HIV (PATH). We will integrate two theoretically-grounded interventions developed by this team – one with a strong peer navigator component (called “Conexiones Saludables”) and the other with a scalable mHealth component (called “LinkPositively”)– into the PATH intervention, with the goal of amplifying the impact of peer navigators on viral suppression among HBPLH. We will integrate, refine, and usability test (Phase 1) these interventions into a unified, community-informed intervention, PATH, to be rigorously evaluated in a RCT (Phase 2). We will test the efficacy of PATH with 375 HBPLH (among whom >33% will report stimulant and/or opioid use in the past 6 months) to: 1) Improve sustained viral suppression (i.e., suppressed viral load at both 6- and 12-month follow-up) compared to usual care; 2) Examine the theory-informed mediators (e.g., self- efficacy to engage in HIV care, HIV stigma) through which PATH has the greatest impact on sustained viral suppression among HBPLH; and 3) Explore whether PATH significantly affects substance-related outcomes (e.g., frequency of substance use, engagement in substance abuse treatment) when compared to usual care among those using substances (i.e., stimulants and/or opioids).