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

通过生活经验和我作为一名青少年医学医生的地位，我目睹了终身的 健康结果的差异对弱势青少年和年轻人（AYAs）造成的后果。 这推动了我的长期目标，即制定干预措施，使AYA，提供者和成年人能够 支持AYA获得对性健康的各个方面产生积极影响的技能，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丸，已被证明是一种高度有效的预防方法。 预防艾滋病毒感染的有效生物医学工具。然而，PrEP的好处尚未得到体验。 在所有有艾滋病毒感染风险的人群中，特别是，PrEP的使用率和依从率很低 在黑人中，特别是黑人青少年和年轻人（AYAs），这可能解释了 艾滋病毒在许多黑人社区的感染率。尽管PrEP的使用和遵守存在许多障碍， 黑人，包括对风险的低认识;坚持服药方案和就诊时间表的挑战;艾滋病毒-和 与性别有关的耻辱，很少有解决方案可以改善这一人群的PrEP使用，特别是在 黑阿雅。增加PrEP依从性的干预可能对黑人AYA特别重要， 南方腹地，特别是在亚拉巴马等州，该州被命名为美国的地理热点。 卫生和人类服务部的结束艾滋病毒流行10年计划。扎根于社会认知 理论，并建立在以前发表的数据，这项拟议的研究将整合AYA信任的成人社会 支持与现有的移动的健康（mHealth）应用程序（HealthMpowerment应用程序）进行二元通信， 促进增加PrEP的使用和坚持之间的黑色AYAs在南方腹地。超过一半的新 亚拉巴马的艾滋病毒感染发生在农村社区，我们将与城市社区合作伙伴合作， 和农村地区，并建立两个社区咨询委员会，一个与黑人阿雅和一个与成年人提供 支持黑人阿亚，以确保该应用程序符合城市和农村黑人阿亚的需求。具体来说，这多... 方法研究将采用定性访谈和离散选择实验调查，以确定1）信任的成年人 黑色AYA将理想的合作伙伴，2）什么信息值得信赖的成人支持将需要支持黑色 AYAs在PrEP坚持，和3）应用程序功能，黑色AYAs和他们信任的成人支持认为最好的 支持围绕AYA PrEP使用的二元通信。经过改编后，该应用程序将由Black AYA进行试点 14至21岁，以通知申请R34资助一个更大的试点研究。如果在未来的临床试验中得到验证， 通过临床试验，这种干预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，以及关键的 在这个严格的建议中体现的教学课程将建立在我的临床专业知识和强大的背景之上 建立社区伙伴关系，并提供我成为发展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.