Integration of Trusted Adult Supports into the HealthMpowerment App to Improve Black Adolescent and Young Adult PrEP Use

通过亲身经历和我作为一名青少年内科医生的职位，我见证了一生 健康结果的差异对易受伤害的青少年和青壮年的影响。 这推动了我开发干预措施的长期目标，使AYA、提供者和成年人能够 支持Aya获得对性健康各方面都有积极影响的技能，包括艾滋病毒预防。 暴露前预防(PrEP)是一种每日或间歇服用的口服药片，已被证明是一种高度有效的药物。 预防艾滋病毒感染的有效生物医学工具。然而，PrEP的好处还没有得到体验 在所有有艾滋病毒感染风险的人群中都是平等的。特别是，PrEP的使用率和依从率都很低 在黑人中，特别是黑人青少年和年轻人(AYA)中，这可能解释了不成比例的 许多黑人社区的艾滋病毒感染率。尽管在使用和遵守PrEP方面存在许多障碍 黑人，包括对风险的低感知；坚持服用避孕药和探视时间表的挑战；以及艾滋病毒和 与性相关的耻辱，几乎没有解决方案来改善这一人群中PrEP的使用，特别是在 黑人阿亚。增加PrEP遵从性的干预措施可能对黑人AYA特别重要 南方腹地，特别是在阿拉巴马州，该州已被命名为美国 卫生与公众服务部制定了结束艾滋病毒流行的十年计划。植根于社会认知 理论，并基于之前发表的数据，这项拟议的研究将整合阿雅信任的成年人社会 通过现有的移动健康(MHealth)应用程序-HealthM授权应用程序-支持双向通信 促进在南方腹地的黑人AYA中增加PrEP的使用和遵守。超过一半的新用户 阿拉巴马州的艾滋病毒感染发生在农村社区，我们将与城市中的社区合作伙伴合作 和农村地区，并创建两个社区咨询委员会，一个由黑人协会组成，另一个由成年人提供 支持黑人AYA，以确保这款应用程序适合城市和农村黑人AYA的需求。具体地说，这个多- 方法研究将使用定性访谈和离散选择实验调查来确定1)值得信任的成年人 黑人AYA最理想的合作伙伴，2)受信任的成年人支持需要哪些信息来支持布莱克 Ayas遵守PrEP，3)应用程序功能，黑人Ayas和他们信任的成年人支持认为最好的 支持围绕Aya PrEP使用的二进制通信。改编后，这款应用将由Black Ayas进行试点 14至21岁通知申请R34资金进行更大规模的试点研究。如果在未来的临床中得到验证 试验表明，这一干预措施可能有助于缓解艾滋病毒发病率的差异。除了提供 量身定制的健康干预，全面的体验式培训，专家指导和建议，以及危重 在这份严谨的提案中体现的教学课程将建立在我的临床专业知识和坚实的背景之上 建立社区伙伴关系，并提供我成为开发领导者所需的额外技能 健康行为干预措施的重点是减少性健康和生殖健康结果方面的差异。

Through lived experiences and my position as an adolescent medicine physician, I have witnessed the lifelong consequences that disparities in health outcomes impose on vulnerable adolescents and young adults (AYAs). This has fueled my long-term goal of developing interventions that empower AYAs, providers, and adults who support AYA acquisition of skills that positively impact all aspects of sexual health, including HIV prevention. Pre-exposure prophylaxis (PrEP) for HIV, a daily or intermittently dosed oral pill, has been shown to be a highly effective biomedical tool for preventing HIV infection. However, the benefits of PrEP have not been experienced equally among all populations with HIV acquisition risk. In particular, PrEP use and adherence rates are low among Blacks, especially Black adolescents and young adults (AYAs), which may explain the disproportionate rates of HIV in many Black communities. Although there are many barriers to PrEP use and adherence among Blacks, including low perception of risk; challenges adhering to a pill regimen and visit schedule; and HIV- and sex-related stigma, few solutions have been shown to improve PrEP use in this population, especially among Black AYAs. An intervention that increases PrEP adherence may be of particular importance for Black AYAs in the Deep South, particularly in states such as Alabama, which has been named a geographic hotspot in the Department of Health and Human Service’s Ending the HIV Epidemic 10-year plan. Grounded in Social Cognitive Theory, and building on previously published data, this proposed study will integrate AYA-trusted adult social support dyadic communication with an existing mobile Health (mHealth) app–the HealthMpowerment app–to facilitate increased PrEP use and adherence among Black AYAs in the Deep South. As more than half of new HIV infections in Alabama occur in rural communities, we will collaborate with community partners within urban and rural areas and create two community advisory boards, one with Black AYAs and one with adults providing support to Black AYAs, to ensure this app fits the needs of urban and rural Black AYAs. Specifically, this multi- methods study will use qualitative interviews and discrete choice experiment surveys to identify 1) trusted adults Black AYAs would ideally partner with, 2) what information trusted adult supports would need to support Black AYAs in PrEP adherence, and 3) app features that Black AYAs and their trusted adult supports feel would best support dyadic communication around AYA PrEP use. After adaptation, the app will be piloted by Black AYAs 14 to 21 years old to inform an application for R34 funding of a larger pilot study. If validated in future clinical trials, this intervention could prove helpful in alleviating disparities in HIV incidence. In addition to providing a tailored health intervention, the comprehensive experiential training, expert mentorship and advising, and critical didactic coursework embodied in this rigorous proposal will build on my clinical expertise and strong background building community partnerships and provide the additional skills I need to become a leader in the development of health behavior interventions focused on reducing disparities in sexual and reproductive health outcomes.