Piloting an App-Based Just-in-Time Adaptive Ecological Momentary Intervention to Reduce Substance Use among HIV-Positive Sexual MinorityMen

摘要 在美国，性少数族裔男性(SMM)感染艾滋病毒的比例高于 普通民众。对于这一人群来说，交叉性少数群体和艾滋病毒相关的压力增加了 增加健康风险的一般生活应激源。研究表明，两者之间存在双向联系 心理社会压力和生理艾滋病毒进展，包括CD4下降和病毒载量增加。 然而，压力不仅与艾滋病毒的进展有关，它还与传播危险行为有关 (TRB)，例如药物不遵守和物质使用。物质使用是一个特别重要的风险 艾滋病毒传播的因素。除了注射毒品的风险外，娱乐使用还与性行为有关 TRB和SMM中艾滋病毒风险的增加。因此，针对应激反应的干预措施可能是 对于使用携带艾滋病毒(LWH)的SMM(SUSMM)的物质减少艾滋病毒风险特别有用。 积极的情绪和以正念为基础的干预在减少不同领域的压力方面显示出了希望 患有包括艾滋病毒在内的慢性病的人口。然而，尽管SMM代表了大多数 美国艾滋病毒人群和SUSMM尤其经历了突出的、独特的压力源，很少有研究 检查了这些干预措施及其对SuSMM-LWH的潜在健康益处。此R34应用程序构建 关于我们在积极情绪诱导和正念领域的试点工作，因为潜在的干预措施即将到来 改善SMM-LWH中与艾滋病毒相关的健康状况。在我们的概念验证试点(n=22)中，我们适应了 为移动应用程序交付提供综合的积极情绪和正念干预。我们的试点研究结果表明 移动APP是SMM-LWH可以接受和可行的交付平台。然而，SuSMM-LWH 体验独特的压力源(例如，物质使用耻辱)，并体验更多的干预障碍。 虽然这种干预的面对面版本在一项随机对照试验中显示了有效性，但 SuSMM-LWH，我们还没有评估通过移动应用程序提供它的可接受性和可行性 人口。我们建议首先通过SUSMM-LWH的样本来试点我们现有的基于APP的干预措施 收集社区反馈，用于针对目标定制应用程序设计和干预内容 人口。在第二阶段，我们将试行因子优化试验，以评估两个方案的可接受性和可行性 可增强我们的即时适应性生态瞬时干预(EMI)设计的其他功能 和送货：(1)除了每天一次的固定调查和(2)每天一次的随机渴望提示 除了我们基于手机的EMI之外，智能手表。来自这个形成性试点的数据将为开发 后续研究拨款申请，以进行更大的阶乘优化试验，以评估每个 这些新特征(及其组合)影响了我们干预的有效性。这之后将是 随后的随机对照试验来评估我们优化干预的有效性，这将有一个 对SUSMM-LWH的物质使用和其他与艾滋病毒相关的结果产生强大和持续的影响。

ABSTRACT In the United States (U.S.), sexual minority men (SMM) are disproportionately affected by HIV compared to the general population. For this population, intersectional sexual minority and HIV-related stress add to general life stressors to increase health risks. Research demonstrates a bidirectional association between psychosocial stress and physiological HIV progression, including CD4 decline and increased viral load. However, stress is not only associated with HIV progression, it is also linked to transmission risk behaviors (TRB), such as medication non-adherence and substance use. Substance use is a particularly important risk factor for HIV transmission. In addition to injection drug use risk, recreational use is associated with sexual TRB and increased risk for HIV among SMM. As such, interventions which target stress responses may be particularly useful for HIV risk reduction among substance using SMM (SUSMM) living with HIV (LWH). Positive affect and mindfulness-based interventions have shown promise in reducing stress across various populations living with chronic illness, including HIV. However, despite the fact SMM represent a majority of the U.S. HIV+ population and SUSMM in particular experience prominent, unique stressors, few studies have examined these interventions and their potential health benefits for SUSMM-LWH. This R34 application builds on our pilot work in the areas of positive affect induction and mindfulness as potential intervention approaches to improve HIV-related health outcomes among SMM-LWH. In our proof-of-concept pilot (n=22), we adapted an integrative positive affect and mindfulness intervention for mobile app delivery. Our pilot findings suggest the mobile app is an acceptable and feasible delivery platform for SMM-LWH. However, SUSMM-LWH experience unique stressors (e.g. substance use stigma), and experience additional barriers to intervention. While the in-person version of this intervention demonstrated efficacy in a randomized control trial with SUSMM-LWH, we have yet to assess acceptability and feasibility for delivering it via mobile app with this population. We propose to first pilot our existing app-based intervention with a sample of SUSMM-LWH to gather community feedback, which will be used to tailor the app design and intervention content for the target population. In Phase 2, we will pilot a factorial optimization trial to assess acceptability and feasibility of two additional features that may enhance our just-in-time-adaptive ecological momentary intervention (EMI) design and delivery: (1) random craving prompts throughout the day in addition to a fixed, once-daily survey and (2) a smart watch in addition to our phone-based EMI. Data from this formative pilot will inform the development of subsequent research grant application to conduct a larger factorial optimization trail to assess how each of these new features (and their combination) impact the effectiveness of our intervention. This will be followed by a subsequent randomized control trial to evaluate efficacy of our optimized intervention, which will have a powerful and sustained effect on substance use and other HIV-related outcomes for SUSMM-LWH.