Mhealth for Pre-exposure Prophylaxis Adherence by Young Adult MSM

摘要：环境与健康组织、塔夫茨艾滋病毒/艾滋病诊所和波士顿地区PrEP 实践社区将在Patricia Weitzman博士的领导下合作，以 开发和测试有史以来第一个单独定制的 对发展和文化敏感的移动(MHealth)PrEP遵守工具。它的目标是 文化多元化，20-29岁的年轻成年男性与男性发生性行为(YMSM)。当PrEP为 每天服用，可以将艾滋病毒风险降低高达92%。疾控中心估计PrEP适用于 美国50万男男性接触者Impact模型显示，即使适度遵守PrEP也可能减少新的 男男性接触者中的HIV感染率在20年内增加了29%。最近艾滋病病毒感染的上升在 20-29岁的年轻人，特别是少数族裔的YMSM，指出了PrEP摄取和 对不同文化的基督教青年会的坚持支持。在PrEP试验中，年龄较小的人 始终如一与低PrEP依从性相关。广泛的手机普及率在 年轻人使mHealth成为提供PrEP坚持支持的理想、低成本方法 基督教青年会。我们将对年轻人决策的发展理解与 来自社会学习理论和积极心理学的支持PrEP坚持的原则。 建议的项目是基于Weitzman博士成功的第一阶段(和当前阶段 2)针对HIV+非裔美国人的抗逆转录病毒治疗(ART)mHealth依从性干预， 它将量身定做的药片提醒与对年龄和文化敏感的激励和 教育文本。专家建议在经过验证的ART基础上建立PrEP依从性干预 依从性干预正如许多PrEP依从性促进者与ART一样。此外， 越来越多的关于mHealth的文献表明，它是一种强大的方法来支持跨 条件。除了建立在我们现有技术的mHealth工具之外，我们还解决了促进者/障碍 在PrEP随机对照试验后续研究和CDC PrEP遵守建议中确定。 此外，具有不同YMSM的形成性焦点小组将使我们能够识别和瞄准独特的 这一组中的遵守障碍和促进者。干预将提供量身定制的药片 使用PrEP教育文本以及对发展敏感的激励文本进行提醒。 我们将包括睡眠卫生和饮酒信息，这些信息与年轻人有直接关系 成年人。通过使用低成本、可访问的移动电话工具，干预消除了几个 获得支持的障碍，这可能是低收入和少数族裔的一个特别问题 病人。我们的首要目标是帮助阻止青年男性接触者中艾滋病毒的上升。

Abstract: Environment and Health Group, Tufts HIV/AIDS Clinic, and the Boston-area PrEP Community of Practice will collaborate under the leadership of Patricia Weitzman, PhD, to develop and test the feasibility and short-term effectiveness of the first-ever individually-tailored, developmentally- and culturally-sensitive, mobile (mhealth) PrEP adherence tool. It will target culturally-diverse, young adult men ages 20-29 who have sex with men (YMSM). When PrEP is taken daily, it can reduce HIV risk by up to 92%. The CDC estimates PrEP is appropriate for 500,000 MSM in the U.S. Impact models show even modest PrEP adherence could reduce new HIV infections among MSM by 29% over 20 years. The recent rise in HIV infection among young adults age 20-29, particularly minority YMSM, points to the value of PrEP uptake and adherence support for culturally-diverse YMSM. In PrEP trials, younger age was the most consistent correlate with low PrEP adherence. Extensive mobile phone penetration among young adults makes mhealth an ideal, low-cost method for providing PrEP adherence support to YMSM. We bring together a developmental understanding of young adult decision making with principles from social learning theory and positive psychology for supporting PrEP adherence. The proposed project is based on Dr. Weitzman's successful Phase 1 (and current Phase 2) anti-retroviral therapy (ART) mhealth adherence intervention for HIV+ African Americans, which combined tailored pill reminders with age- and culturally-sensitive motivational and educational texts. Experts suggest building PrEP adherence interventions on proven ART adherence interventions as many PrEP adherence facilitators are the same as ART. Moreover, the growing literature on mhealth shows it is a powerful approach to supporting adherence across conditions. In addition to building on our prior ART mhealth tool, we address facilitators/barriers identified in PrEP RCT follow up studies, and CDC PrEP adherence recommendations. Moreover, formative focus groups with diverse YMSM will allow us to identify and target unique adherence barriers and facilitators in this group. The intervention will provide tailored pill reminders with PrEP education texts, as well as developmentally-sensitive motivational texts. We will include sleep hygiene and alcohol use messages, which have direct relevance to young adults. By using a low-cost, accessible mobile phone tool, the intervention eliminates several access barriers to support, which can be a particular problem for low income and minority patients. Our overarching goal is to help stop the rise in HIV among YMSM.