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，性少数男性（SMM）受艾滋病毒的影响不成比例， 普通民众。对于这一人群，交叉性少数群体和艾滋病毒相关的压力增加了 一般的生活压力，以增加健康风险。研究表明， 心理社会压力和生理HIV进展，包括CD 4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，还与传播风险行为有关 (TRB)例如药物不依从和物质使用。物质使用是一个特别重要的风险 艾滋病毒传播的因素。除了注射吸毒风险外，娱乐性吸毒还与性行为有关。 TRB和SMM中艾滋病毒风险增加。因此，针对压力反应的干预措施可能是 特别适用于降低携带艾滋病毒（LWH）的物质使用SMM（SUSMM）中的艾滋病毒风险。 积极的影响和基于正念的干预措施在减少各种压力方面表现出了希望。 患有慢性病的人口，包括艾滋病毒。然而，尽管SMM代表了大多数 美国HIV阳性人群和SUSMM尤其经历了突出的、独特的压力源，很少有研究 研究了这些干预措施及其对SUSM-LWH的潜在健康益处。此R34应用程序构建 关于我们在积极影响诱导和正念领域的试点工作，作为潜在的干预方法 改善SMM-LWH中与艾滋病毒相关的健康结果。在我们的概念验证试验（n=22）中，我们适应了 一个整合的积极影响和正念干预的移动的应用程序交付。我们的初步发现表明 移动的应用程序是SMM-LWH可接受且可行的递送平台。然而，SUSM-LWH 经历独特的压力源（例如，物质使用的耻辱），并经历额外的干预障碍。 虽然这种干预的个人版本在一项随机对照试验中证明了有效性， SUSMM-LWH，我们还没有评估通过移动的应用程序提供它的可接受性和可行性， 人口我们建议首先使用SUSM-LWH样本对我们现有的基于应用程序的干预进行试点， 收集社区反馈，用于为目标定制应用程序设计和干预内容 人口在第二阶段，我们将进行一项析因优化试验，以评估两种方法的可接受性和可行性。 可以增强我们的及时适应性生态瞬时干预（EMI）设计的附加功能 和交付：（1）除了固定的，每天一次的调查外，全天随机的渴望提示，以及（2） 智能手表以及基于手机的EMI。这一形成性试点的数据将为发展提供信息， 随后的研究补助金申请进行更大的因子优化试验，以评估 这些新的特点（及其组合）影响到我们干预的有效性。随后将 随后的随机对照试验，以评估我们的优化干预的有效性，这将有一个 对SUSM-LWH的药物使用和其他HIV相关结局具有强大和持续的影响。

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.