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

项目总结 在美国，拉美裔和黑人在艾滋病毒护理方面继续存在显著的差异 与非西班牙裔白人相比，艾滋病毒携带者(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距也存在于圣地亚哥县，这是 结束艾滋病毒流行倡议。共同出现的合并症加剧了差异， 包括药物使用。同行导航员，作为社区卫生工作者的一种类型，已经被证明发挥了作用 发挥有意义的作用，支持公共卫生部门继续参与发展中国家的护理工作。更严格的研究是 需要评估同行导航员对美国艾滋病毒护理连续体的影响，而同行导航员 可能会促进PLH的积极成果，但传统的同行导航方法在 支持对等导航器的资源有限的真实环境。可扩展的移动健康干预 需要采取办法来加强同伴对HBPLH中艾滋病毒护理连续成果的影响。 Mobile(M)Health和其他技术提供了用于通过渠道进行干预传递的可扩展平台(例如， 在线、移动应用、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。将对等导航器和mHealth结合到统一的、可扩展的干预中 加强同伴导航员对HBPLH中艾滋病毒护理连续成果的影响，同时 减少在临床环境中支持同行导航员所需的资源，有效地实现理想的平衡 在最大化临床效应大小和降低同行导航器成本之间，以促进可持续性。合作伙伴关系 以社区诊所(San Ysidro Health，SYH)为基础，在南部瑞安·怀特模式下为HBPLH提供服务 圣地亚哥，我们提出了一种称为Peers plus的mHealth对等导航器干预的双臂RCT(n=375) 用于治疗艾滋病毒的移动应用程序(Path)。我们将整合两个以理论为基础的干预措施 由这个团队提供--一个具有强大的同级导航器组件(称为“Conexiones Saludables”)，另一个具有 一个可扩展的mHealth组件(称为“LinkPosially”)-进入路径干预，目标是放大 同伴导航者对HBPLH病毒抑制的影响。我们将进行集成、优化和可用性测试 (阶段1)将这些干预措施纳入统一的、社区知情的干预措施，并进行严格评估 在随机对照试验(阶段2)中。我们将用375个HBPLH测试PATH的疗效(其中33%将报告兴奋剂 和/或在过去6个月中使用阿片类药物)以：1)改善持续的病毒抑制(即，在 6个月和12个月的随访)与常规护理的比较；2)检验理论知情的中介(例如，自我 从事艾滋病毒护理的有效性、艾滋病毒污名)通过哪种途径对持续病毒的影响最大 HBPLH之间的抑制；以及3)探索路径是否显著影响物质相关结果 (例如，使用药物的频率、参与药物滥用治疗)与日常护理相比 在使用物质(即兴奋剂和/或阿片类药物)的人中。

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).