LinkPositively: A Technology-Delivered Peer Navigation and Social Networking Intervention to Improve HIV Care Across the Continuum for Black Women Affected by Interpersonal Violence

项目总结 在美国，患有艾滋病毒/艾滋病(WLHA)的黑人妇女不太可能从事护理，遵守 抗逆转录病毒治疗(ART)，与白色WLHA相比，病毒抑制。与此同时，黑人女性 也不成比例地受到人际暴力的影响--身体、性和/或心理虐待 现任或前任亲密伴侣或非亲密伴侣--可能与精神健康状况不佳和/或 物质使用障碍，进一步导致ART不依从性、CD4计数降低和病毒减少 压制。同行导航，虽然被强调为改善艾滋病毒护理的成功护理模式 结果，需要艾滋病毒服务机构往往缺乏的资源。一种可扩展和可持续的解决方案是 使用移动健康(MHealth)智能手机应用程序(“应用程序”)。尽管有增加了的 为高危和艾滋病毒阳性男男性行为者和青年的艾滋病毒预防和护理制定的移动健康干预措施， 我们不知道有任何方法可以改善黑人的护理保留率、ART依从性和病毒抑制 WLHA，也没有任何针对黑人女性人际交往经历的mHealth干预措施 暴力。为了弥补这一差距，我们将开发并试点测试一款根据文化定制的、了解创伤信息的智能手机 这款名为LinkPositive的应用程序是为受人际暴力影响的黑人WLHA而设计的。核心组件 LinkPositive包括：a)虚拟对等导航，包括电话和文本签到以及每周4次一对一 一次视频会议，培养应对障碍和应对护理的技能；b)社交网络平台 接受同伴支持；c)教育和自我护理数据库，提供健康生活和自我护理提示；d)全球定位系统-- 为艾滋病毒护理和辅助支助服务机构启用资源定位器；和e)抗逆转录病毒治疗自我监测和 提醒系统。在三位一体的影响理论和共性理论的指导下，本研究将 分两个阶段进行，并有相应的目标。在目标1中，4个具有黑人WLHA经验的焦点小组 关于人际暴力，一个有同伴导航员的焦点小组，以及4-6个关键线人采访 供应商将负责确定最有可能支持哪些应用程序特性、内容和功能 随着时间的推移，下载、启动使用和持续参与。目标1将通过以下方式在可用性测试中达到高潮 受人际暴力影响的黑人妇女生活能力评估(n=5)，以最终确定干预内容和程序。在……里面 目标2，我们将对LinkPositive进行试点测试，以评估可行性和可接受性，并确定初步效果 对艾滋病毒护理结果的干预(即，保留护理、坚持抗逆转录病毒疗法、病毒抑制)和 变化机制变量(即社会支持、自我效能感)。参与者将被随机分配到 干预组(n=40)或对照组(Ryan White标准护理组，n=40)，随访时间分别为3-和6- 月份。这项研究将有助于利用技术来促进艾滋病毒预防科学的进步 促进艾滋病毒护理的参与度，同时通过同伴和社交网络改善社会支持-所有这些 在为黑人WLHA提供创伤信息的赞助下，他们有人际暴力的经历。

PROJECT SUMMARY In the US, Black women living with HIV/AIDS (WLHA) are less likely to be engaged in care, adherent to antiretroviral therapy (ART), and virally suppressed compared to White WLHA. Concurrently, Black women are also disproportionately affected by interpersonal violence – physical, sexual, and/or psychological abuse by a current or former intimate partner or non-intimate partner – which may co-occur with poor mental health and/or substance use disorders, further contributing to ART non-adherence, lower CD4 counts, and reduced viral suppression. Peer Navigation, while highlighted as a successful model of care in improving HIV care outcomes, requires resources that HIV service agencies often lack. A scalable and sustainable solution is the use of mobile health (mHealth) smartphone applications (“apps”). Although there has been an increase in mHealth interventions developed for HIV prevention and care among at-risk and HIV-positive MSM and youth, we are unaware of any to improve retention in care, ART adherence, and viral suppression among Black WLHA, nor any mHealth interventions that are responsive to Black women’s experiences with interpersonal violence. To address this gap, we will develop and pilot test a culturally tailored, trauma-informed smartphone app, called LinkPositively, for Black WLHA affected by interpersonal violence. Core components of LinkPositively include: a) Virtual Peer Navigation that includes phone and text check-ins and 4 weekly one-on- one video sessions to build skills to cope with barriers and navigate care; b) Social Networking platform to receive peer support; c) Educational and Self-care database with healthy living and self-care tips; d) GPS- enabled Resource Locator for HIV care and ancillary support service agencies; and e) ART self-monitoring and reminder system. Guided by the Theory of Triadic Influences and Syndemic Theory, the study will be conducted in 2 phases with corresponding aims. In Aim 1, 4 focus groups with Black WLHA with experiences of interpersonal violence, one focus group with peer navigators, and 4-6 key informant interviews with providers will be conducted to determine which app features, content, and functions are most likely to support downloading, initiating use, and sustaining engagement over time. Aim 1 will culminate in usability testing by Black WLHA affected by interpersonal violence (n=5), to finalize intervention components and procedures. In Aim 2, we will pilot test LinkPositively to assess feasibility and acceptability and determine preliminary effects of the intervention on HIV care outcomes (i.e., retention in care, ART adherence, viral suppression) and mechanism of change variables (i.e., social support, self-efficacy). Participants will be randomly assigned to either the intervention (n=40) or control (Ryan White standard of care, n=40) arm, with follow-up at 3- and 6- months. This study will benefit the advancement of HIV prevention science by harnessing technology to promote engagement in HIV care, while improving social support through peers and social networking – all under the auspices of being trauma-informed for Black WLHA with experiences of interpersonal violence.