mHealth intervention for ART adherence and sexual risk reduction among HIV+ YMSM

描述（由申请人提供）：候选人是一名青少年医学专家和费城儿童医院青少年艾滋病毒服务主任，研究重点是使用移动的技术来改善青少年的依从性和其他健康结果。候选人提出了一个职业发展计划，将为她提供的技能和经验，成为一个独立的调查员在青少年艾滋病毒研究领域。除了定量和定性研究方法和健康行为理论的教学课程外，候选人的职业发展将由致力于她成功的国家认可的顾问组成的多学科团队指导。[She将成立一个技术咨询委员会，在移动的健康（mHealth）技术的各个方面提供指导和指导，包括基于技术的健康干预措施的孵化和开发，大数据/机器学习的研究设计和分析技术，游戏化理论，用户界面/响应式设计技术，可用性测试，以及健康行为理论在开发mHealth干预措施中的应用。 职业发展活动将辅之以通过开展原创性研究获得的实践经验。该提案审查了艾滋病毒/艾滋病感染者中男男性行为者（YMSM）的药物依从性和性风险的关键健康行为，并建议开发一种基于移动的电话的干预措施，旨在改善青年在真实的时间和地点需要支持的这些健康行为。AIM 1将描述STI合并感染和病毒学失败的发生率，并通过回顾性图表审查报告HIV+ YMSM分层中这些结局的标准化风险，并通过深入的结构化访谈进一步了解关键的心理和行为因素。利用根据AIM 1的研究结果选择的高风险和低风险青年焦点小组，AIM 2将探讨艾滋病毒+ YMSM如何使用移动的技术，以及他们对各种基于移动的手机工具的态度，以提高依从性和降低性风险。德尔菲方法将首先用于AIM 3，召集一个移动健康和青少年健康专家小组，为青少年性健康技术为基础的干预发展建立共识准则。这些结果与AIM 2的青年投入相结合，将作为开发新的mHealth二级预防艾滋病毒+ YMSM干预措施的指导框架。新的移动健康干预措施由理论驱动的元素组成，例如，包括基于时间和位置的提醒，以及基于个人和团体的游戏激励，然后将进行可用性测试，包括（a）一个焦点小组，对设计和用户体验进行具体反馈，然后（B）进行为期12个月的可行性试验，其中20名青年将安装应用程序，使用情况，满意度，并收集临床结局数据。根据NIMH的 作为研究的优先事项，该提案旨在制定一项创新的二级预防战略，旨在提高艾滋病毒+ YMSM人群的药物依从性和降低性风险。

DESCRIPTION (provided by applicant): The candidate is an adolescent medicine specialist and Director of Adolescent HIV Services at The Children's Hospital of Philadelphia with a research focus on using mobile technology to improve adherence and other health outcomes for adolescents at risk for and living with HIV/AIDS. The candidate proposes a career development program that will provide her with the skills and experience to become an independent investigator in the field of adolescent HIV research. In addition to didactic coursework in quantitative and qualitative research methodology and health behavior theory, the candidate's career development will be guided by a multidisciplinary team of nationally recognized advisors committed to her success. [She will form a Technology Advisory Board for mentorship and preceptorships in all aspects of mobile health (mHealth) technology, including incubation and development of technology-based health interventions, study design and analysis techniques for big data/machine learning, gamification theory, user interface/responsive design techniques, usability testing, and the application of health behavior theory to develop mHealth interventions.] Career development activities will be complemented by practical experience gained through the conduct of original research. This proposal examines key health behaviors of medication adherence and sexual risk among young men who have sex with men (YMSM) living with HIV/AIDS, and proposes to develop a mobile phone based intervention targeted at improving these health behaviors in the real times and places youth need support. AIM 1 will describe the incidence of STI co-infections and virologic failure and report the standardized risk of these outcomes across strata of HIV+ YMSM through retrospective chart review augmented by in-depth structured interviews for further understanding of key psychosocial and behavioral factors. Using focus groups of youth at high- and low-risk, selected based on findings from AIM 1, AIM 2 will explore how HIV+ YMSM use mobile technology, and their attitudes towards various mobile phone-based tools to improve adherence and reduce sexual risk. Delphi methodology will first be used in AIM 3 to convene a panel of mHealth and adolescent health experts to establish consensus guidelines for adolescent sexual health technology-based intervention development. These results, combined with youth input from AIM 2, will serve as a guiding framework for development of a new mHealth secondary prevention intervention for HIV+ YMSM. The new mHealth intervention composed of theory-driven elements, for example, including time and location-based reminders, and individual and group-based gaming incentives will then undergo usability testing consisting of (a) a focus group for specific feedback on design and user experience and then (b) a 12-month feasibility trial where 20 youth will have the application installed and usage, satisfaction, and clinical outcome data will be collected. In line with NIMH's research priorities, this proposal sets out to develop an innovative secondary prevention strategy targeting improved medication adherence and sexual risk reduction among HIV+ YMSM.