mLab App for Improving Uptake of rapid HIV self-testing and Linking Youth to Care

感染艾滋病毒的青年人数继续上升，他们在艾滋病的每个阶段都有不成比例的比例。 护理连续体。与这一应用程序最相关的是，据估计，在美国，只有不到一半的艾滋病毒感染青年 美国已被诊断出感染艾滋病毒，在过去十年中，年轻人中与艾滋病有关的死亡人数有所增加 尽管所有其他年龄段的死亡率都有所下降，但这表明迫切需要增加对青年的检测。 黑人和拉丁裔青年患艾滋病毒相关结果差的风险增加，与 白人青年。移动健康(MHealth)技术是一种功能强大的相关工具，代表着一种很有前途的方法 以改善感染艾滋病毒的青年的结果。年轻人是智能手机的狂热使用者和重度用户 数字技术，这些技术提供了为发展阶段量身定制干预措施的机会 个人需要。重要的是，这些技术能够实时和生态地提供干预 设置。这创造了通过移动和互联健康方法远程接触年轻人的机会 加强他们的艾滋病毒护理、持续参与和治疗成果。作为回应，我们的研究团队开发了 MLab App，一项创新的移动和互联技术，将艾滋病毒预防信息与推送相结合 完成HIV检测的通知/提醒和自动图像处理功能，以提供可访问、 客观、安全和实时地反馈基于家庭的OraQuick(横向流动分析)HIV检测结果。MLab应用程序 还包含创新的自动数据收集和结果报告功能。我们初步工作的结果 在纽约市，年轻人认为mLab App有用、易于使用，并且在改善健康方面有效 结果，并打算使用这项技术。我们在非洲的初步工作结果支持了敏感性和 解释侧向流动分析结果的成像算法的特异性。理论上以健康为导向 信息技术可用性评估模型(Health-ITUEM)，拟议的项目将完善和测试下一个- 在移动平台上提供世代诊断干预，以改善艾滋病毒检测和与护理挂钩的结果 在艾滋病毒携带者和有感染艾滋病毒风险的青年中。根据RFA-MH-18-606的目标，我们将进行 根据最终用户、专家和我们的青年顾问委员会的意见，谨慎、迭代地进行技术改进。 然后，我们将招募500名高危青年(年龄17-29岁)参加为期12个月的随机对照试验，以评估艾滋病毒检测率的差异 以及干预(MLab App)和对照手臂之间的联动护理。最后，我们将分析ParaData，其定义如下 捕捉与技术交互过程的详细信息的辅助数据，以了解用户的效果 MLab应用程序参与提高艾滋病毒检测率和与护理的联系。通过以下方式提供干预 移动健康技术是改善青年结果的一种很有前途的方法。鉴于普及率很低， 成本、移动技术的便利性，mLab App承诺帮助实现国家 美国的艾滋病毒/艾滋病战略，增加知道自己血清状态的艾滋病毒携带者人数，减少 减少与艾滋病毒有关的差异，并最终降低艾滋病毒传播和感染的风险。

The number of youth living with HIV continues to rise, and they are disproportionately represented at each stage of the care continuum. Most relevant to this application, it is estimated that less than half of HIV-infected youth in the United States (US) have been diagnosed with HIV, and AIDS-related deaths among youth have increased over the past decade despite decreased death rates among all other age groups, pointing to the urgent need for increased testing among youth. Black and Latino youth are at increased risk of poor HIV-related outcomes and have disparate testing rates as compared to White youth. Mobile Health (mHealth) technology is a powerful and relevant tool which represents a promising approach for improving outcomes among youth living with HIV. Youth are avid adopters and heavy users of smartphones and digital technologies, and these technologies offer opportunities to tailor interventions to developmental stages and personal needs. Importantly, these technologies are capable of delivering interventions in real-time and in ecologic settings. This creates an opportunity to remotely reach youth through mobile and connected health approaches to strengthen their HIV care continuum engagement and treatment outcomes. In response, our study team has developed the mLab App, an innovative mobile and connected technology that combines HIV prevention information with push notifications/reminders to complete HIV testing and an automated image processing feature to provide accessible, objective, secure, and real-time feedback on home-based OraQuick (lateral flow assay) HIV test results. The mLab App also contains an innovative automated data collection and a results reporting feature. Findings from our preliminary work in New York City indicate that youth perceive the mLab App as useful, easy to use, and effective at improving health outcomes and intend to use the technology. Findings from our preliminary work in Africa support the sensitivity and specificity of the imaging algorithm for interpreting lateral flow assay results. Theoretically-guided by the Health Information Technology Usability Evaluation Model (Health-ITUEM), the proposed project will refine and test a next- generation diagnostic intervention delivered on a mobile platform to improve HIV testing and linkage-to-care outcomes among youth living with and at-risk for HIV. Well in line with the objectives of RFA-MH-18-606, we will conduct a careful, iterative process of technology refinement based on input from end users, experts, and our youth advisory board. We will then enroll 500 high-risk youth (age 17-29 years) in a 12-month RCT to assess differences in HIV testing rates and linkage to care between the intervention (mLab App) and control arm. Finally, we will analyze paradata, defined as auxiliary data that capture details about the process of interaction with the technology, to understand the effect of user engagement of the mLab App on improving HIV testing rates and linkage to care. Interventions delivered through mHealth technology represent a promising approach for improving outcomes among youth. Given the pervasiveness, low cost, and convenience of mobile technology, the mLab App holds promise to help achieve the goals of the National HIV/AIDS Strategy in the US by increasing the number of persons living with HIV who know their serostatus, decreasing HIV-related disparities, and ultimately reducing the risk of HIV transmission and acquisition.