A Mobile Health Application for Engagement in Care among Youth Living with HIV

摘要/项目摘要： 在美国，只有不到6%的青年艾滋病毒携带者(YLWH)实现了艾滋病毒病毒抑制。这份健康 差距延伸到整个艾滋病毒护理连续体，因为较年轻的年龄与 和较晚的艾滋病毒诊断，较低的护理参与度，较低的抗逆转录病毒治疗(ART)依从性水平，以及 更糟糕的艾滋病毒临床结果。为了应对这一关键的公共卫生困境，并与国家 卫生研究所的优先研究课题(即，“减少新发癌症发病率的健康差距” 艾滋病毒感染或艾滋病毒感染者/艾滋病患者的治疗结果“)，我们的研究小组建议 开发新的移动健康应用程序(APP)，以提高对医疗保健的参与度和对艺术的坚守 并在18-29岁的YLWH中试行测试这款移动健康应用程序。我们研究的目的是： 目标1：建立我们的理论指导模式和形成性工作，以完成我们小说的发展 个性化移动健康应用程序WYZ(发音为“WISE”)，用于改善YLWH中的艾滋病毒临床结果。 我们的研究团队将与加州大学旧金山分校的信息服务部门合作 使用迭代的以人为中心的设计方法完成WYZ的开发。这将通过以下方式完成 添加与药房和实验室数据库的数据集成，创建与Android兼容的版本 这款应用基于我们正在进行的iOS版本，基于现场测试的用户体验数据进行了改进， 以及对参加现场测试的青年初级保健提供者进行定性访谈。 目的2：进行先导性随机试验以评估其可行性、可接受性和初步临床影响 YLWH及其HCP中使用WYZ的情况(即依从性、血浆HIV RNA和CD4+细胞计数)。 目标2由两个子目标组成： 2A。根据定义的指标、通过以下方式检查使用所见即所得的可行性和可接受性 与参与者的定性离职访谈，以及病毒学/免疫学结果对临床的初步影响 随机分为干预组和等待名单对照组。 2B。通过个别定性访谈评估参与者的HCP对WYZ的可接受性。 我们假设我们的移动健康应用程序将是可行和可接受的，并将导致改进 HIV的临床结果。我们的研究意义重大，因为它有可能提高护理参与度， YLWH患者的抗逆转录病毒治疗依从性和临床结果。我们的研究是创新的，因为我们将采用一种 一套以技术为基础的方法，以改善青瓦台的信息、动机和行为技能。vt.在.的基础上 完成后，我们将准备在随后的大规模RCT中测试该应用程序的效果 不成比例地受到艾滋病毒影响的人群，临床结果不佳的风险增加。

Abstract/Project Summary: In the US, fewer than 6% of all youth living with HIV (YLWH) achieve HIV viral suppression. This health disparity extends to the entire HIV care continuum in that there is a strong association between younger age and later HIV diagnosis, lower engagement in care, lower levels of antiretroviral therapy (ART) adherence, and worse HIV clinical outcomes. In response to this critical public health dilemma and aligned with the National Institute of Health's High Priority Topics of Research (i.e., “to reduce health disparities in the incidence of new HIV infections or in treatment outcomes of those living with HIV/AIDS”), our research team proposes to develop a novel mobile health application (“app”) to improve engagement in health care and ART adherence and to pilot test this mobile health app in 18-29 year-old YLWH. The aims of our study are to: Aim 1: Build on our theory-guided model and formative work to complete the development of our novel personalized mobile health app, WYZ (pronounced “wise”), for improved HIV clinical outcomes among YLWH. Our research team will work with the University of California, San Francisco's Information Services Unit to complete the development of WYZ using an iterative Human-Centered Design approach. This will be done by adding data integration with pharmacy and laboratory databases, creation of an Android-compatible version of the app based on our in-progress iOS version, refinement based on user-experience data from field testing, and qualitative interviews with the primary care providers of the youth participating in the field testing. Aim 2: Conduct a pilot randomized trial to assess the feasibility, acceptability, and preliminary clinical impact (i.e., adherence, plasma HIV RNA, and CD4+ cell count) of the use of WYZ among YLWH and their HCPs. Aim 2 consists of two sub-aims: 2a. Examine feasibility and acceptability of the use of WYZ based on defined metrics, acceptability through qualitative exit interviews, and preliminary clinical impact by virologic/immunologic outcomes with participants randomized to the intervention versus the wait-list control. 2b. Assess the acceptability of WYZ by participants' HCPs through individual qualitative interviews. We hypothesize that our mobile health app will be feasible and acceptable and will result in improved HIV clinical outcomes. Our study is significant because it has the potential to improve engagement in care, ART adherence, and clinical outcomes among YLWH. Our study is innovative because we will employ a novel suite of technology-based methods to improve information, motivation, and behavioral skills in YLWH. Upon completion, we will be ready to test the efficacy of this app in a subsequent large-scale RCT among this population that is disproportionately impacted by HIV and at elevated risk for poor clinical outcomes.