mHealth for ART adherence by HIV+ African Americans age 45 & older

移动医疗促进 45 岁非洲裔美国人艾滋病毒依从性治疗

• 批准号: 9233205
• 负责人: Patricia Flynn Weitzman
• 金额: $ 39.49万
• 依托单位: ENVIRONMENT AND HEALTH GROUP, INC.
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-18 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9233205
• 关键词: AIDS/HIV problem; Address; Adherence; Adult; Affect; African American; Age; Aging; Back; Behavioral; Boston; Car Phone; Centers for Disease Control and Prevention (U.S.); Clinic; Cognitive aging; Collaborations; Communication; Counseling; Data; Effectiveness; Elderly; Environment; Feeling; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Health education; Holidays; Immune system; Impaired cognition; Individual; Intake; Intervention; Marketing; Measures; Mediator of activation protein; Medication Management; Memory; Memory impairment; Modeling; Morbidity - disease rate; Motivation; National Institute of Drug Abuse; Not Hispanic or Latino; Outcome; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Phase; Play; Population; Primary Health Care; Provider; Psychological reinforcement; Psychology; Psychosocial Assessment and Care; Randomized Controlled Trials; Reporting; Research; Role; Self Efficacy; Services; Stress; Testing; Text; Time; Viral; Visual; Vulnerable Populations; age group; aged; allostatic load; antiretroviral therapy; base; behavioral economics; commercialization; cost; disparity reduction; evidence base; experience; functional disability; health disparity; improved; mHealth; medication compliance; mortality; negative affect; pill; prevent; primary outcome; psychologic; public health relevance; response; smoking cessation; therapy adherence; tool

 DESCRIPTION (provided by applicant): Environment and Health Group (EHG), Inc., in collaboration with a number of Boston MA and Columbia SC based organizations, seeks to enhance, test, and commercialize an individually-tailored, culturally-sensitive, positive-psychology and behavioral-economics based, mobile health intervention to promote ART adherence, increase ART self-efficacy and reduce feelings of stress burden among HIV positive African Americans age 45 and older. African Americans represent a growing portion (41%) of people living with HIV (CDC, 2012; 2014); by 2015, those age 50+ will account for half of all cases of HIV/AIDS in the U.S. (NIDA, 2012). Poor ART adherence contributes to disparities in HIV/AIDS outcomes among older African Americans. The proposed project is based on EHG's previous research with HIV+, age 50 years and older, African American adults. That research revealed personalized pill reminder text messages with positive-psychology based motivational and educational messages are effective at addressing two major barriers to ART adherence in this group: 1) memory deficits resulting from the combined effects of HIV, cognitive aging, and increased allostatic load, and 2) low motivation due to lack of ART self efficacy and negative affect. Findings showed significant improvement in ART adherence scores and marginally significant improvement in ART self- efficacy scores. While affect scores did not change, qualitative findings showed the intervention helped reduce feelings of stress burden. Supporting ART adherence is key to reducing health disparities among HIV+ African Americans. Doing so for those, age 45 and older-who are most vulnerable to cumulative, age-accelerating effects of HIV infection and allostatic load-is urgent, which is why we are lowering the age cut-off from 50 to 45 in Phase II. To date, no ART adherence support intervention has been developed for this highly-vulnerable group. The Phase II project will enhance the existing mobile intervention by offering: 1) a two-way communication capability through which participants can: i) indicate "pill taken" in response to pill reminders, and ii) receive a positive visual icon as behavioral-economics based reinforcement for "pill taken" responses; 2) live, real-time pharmacist counseling and medication support; and, 3) the addition of opt-in smoking cessation educational and motivational texts. Overall aims are to: 1) expand mhealth intervention to incorporate new Phase II features; 2) evaluate effectiveness in an RCT of HIV+ African Americans age 45 and older; and 3) prepare marketing and commercialization plans. Our long-term goal is to increase ART adherence, thus decreasing health disparities, among HIV+, African-Americans, age 45+.

 描述（由申请人提供）：环境与健康集团（EHG），Inc.，与马萨诸塞州波士顿和哥伦比亚南卡罗来纳州的一些组织合作，寻求加强、测试和商业化一种个性化定制的、文化敏感的、基于积极心理学和行为经济学的、移动的健康干预措施，以促进抗逆转录病毒疗法的坚持，提高抗逆转录病毒疗法的自我效能，并减少45岁及以上艾滋病毒阳性的非裔美国人的压力负担。非洲裔美国人在艾滋病毒感染者中所占比例越来越大（41%）（CDC，2012; 2014）;到2015年，50岁以上的人将占美国所有艾滋病毒/艾滋病病例的一半（NIDA，2012）。抗逆转录病毒治疗坚持性差导致老年非裔美国人艾滋病毒/艾滋病结果的差异。拟议的项目是基于EHG以前对HIV+，年龄50岁及以上，非洲裔美国成年人的研究。该研究显示，个性化的药丸提醒短信与积极心理学为基础的激励和教育信息是有效地解决两个主要障碍，以艺术坚持在这组：1）记忆缺陷造成的综合影响艾滋病毒，认知老化，并增加非稳态负荷，和2）低动机由于缺乏艺术自我效能和负面影响。研究结果显示，ART依从性评分显著改善，ART自我效能评分略有改善。虽然影响分数没有改变，定性研究结果表明，干预有助于减少压力负担的感觉。支持坚持抗逆转录病毒疗法是减少艾滋病毒阳性非洲裔美国人健康差距的关键。对于那些年龄在45岁及以上的人来说，这样做是紧迫的，他们最容易受到艾滋病毒感染和非稳态负荷的累积、加速衰老的影响，这就是为什么我们在第二阶段将年龄界限从50岁降低到45岁。迄今为止，尚未为这一高度弱势群体制定抗逆转录病毒疗法依从性支持干预措施。第二阶段项目将通过以下方式增强现有的移动的干预：1）双向通信能力，通过该能力，参与者可以：i）响应药丸提醒指示“服用药丸”，以及ii）接收积极的视觉图标，作为基于行为经济学的“服用药丸”响应的强化; 2）实时药剂师咨询和药物支持;以及，3）增加选择性戒烟教育和激励文本。总体目标是：1）扩大移动健康干预，纳入新的第二阶段功能; 2）评估45岁及以上艾滋病毒+非裔美国人的RCT的有效性; 3）准备营销和商业化计划。我们的长期目标是提高抗逆转录病毒疗法的坚持率，从而减少艾滋病毒阳性、非裔美国人、45岁以上人群的健康差距。