PositiveLinks for Youth and Emerging Adults (PL4Y): Adapting a multimodal evidence-based mHealth intervention to increase engagement in HIV care in the Southern US

项目摘要 18-29岁(YLWH)感染艾滋病毒的新兴成年人和青年在任何年龄段中最不可能参与 关注或实现病毒学抑制，南方青年会生活在现代美国艾滋病毒的中心 流行病。在德克萨斯州，年轻人中艾滋病毒快速传播的分子簇突显了错失的机会 包括护理参与和病毒学抑制方面的延迟，以及我们目标中不到20%的YLWH 南得克萨斯州的人口实现了病毒学抑制。我们的长期目标是提高病毒率 通过开发一种用于护理参与的新的移动健康(MHealth)工具来抑制YLWH。 智能手机应用程序(App)等移动健康干预措施迅速被年轻人采用，是一种 在增加YLWH的护理参与度方面未充分利用资源。本项目拟进行适配和中试 Dillingham和Ingersoll开发的现有移动健康工具PositiveLinks Program(PL)的有效性 (共用)。PL是一种多模式干预，包括日常遵守情况评估、预约提醒、安全 与诊所提供者的消息传递，以及在线匿名同行支持网络。PL增加护理 观察性研究中成人HIV感染者(大多数)的参与和病毒学抑制，但没有 曾在青瓦台进行过研究。泰勒(Pi)、Nijhawan(Co-I)和比利亚雷亚尔(Co-I)的形成性研究表明 德克萨斯州的患者和提供者寻求关系干预，基督教青年会要求采用mHealth方法 订婚。我们将使用计划行为理论(TPB)作为理论模型和积极的青年 开发(PYD)作为严格适应和试点测试修改版本的PL，PositiveLinks的一种方法 青年(PL4Y)。 为此，我们将对PositiveLinks进行严格的形成性评估，以使其适应YLWH的需求， 包括：由城规会提供信息的半结构化访谈，YLWH在护理方面遇到挑战 参与和利益攸关方，以及青年咨询委员会的反馈(目标1)。然后我们将开发和 反复调整PL的组件和从形成性中涌现的以青年为重点的新组件 对新诊断、脱离护理或未经病毒学抑制的YLWH进行评估 PYD启发以人为本的设计方法，生成面向青年的PositiveLinks(PL4Y)(目标2)。 最后，我们将对YLWH改编的PL4Y方案进行小型先导随机对照试验 脱离或新参与艾滋病毒护理，以评估其对病毒学抑制的影响(目标3)。喜忧参半 方法过程评估将评估这一新干预措施的可接受性和可行性。 通过这些目标，我们将开发一种创新的关怀参与工具，以满足发展和 青瓦台的社会/结构需求。我们的方法可以作为有效适应移动健康的模型 针对新的目标受众的干预措施，以应对社区的紧急需求。

Project Summary Emerging adults and youth living with HIV 18-29yo (YLWH) are the least likely of any age group to engage in care or achieve virologic suppression, and Southern YLWH live at the epicenter of the modern U.S. HIV epidemic. In Texas, molecular clusters of rapid HIV transmission among youth highlight missed opportunities including delays in care engagement and virologic suppression, and less than 20% of YLWH in our target population in South Texas achieve virologic suppression. Our long-term goal is to improve rates of virologic suppression for YLWH through development of a novel mobile health (mHealth) tool for care engagement. mHealth interventions, such as smartphone applications (apps), are rapidly adopted by youth, and are an underutilized resource in increasing care engagement for YLWH. This project proposes to adapt and pilot test the efficacy of an existing mHealth tool, the PositiveLinks Program (PL), developed by Dillingham and Ingersoll (Co-Is). Pl is a multimodal intervention, including daily adherence assessment, appointment reminders, secure messaging with clinic providers, and an online anonymized peer support network. PL increased care engagement and virologic suppression in adults (majority >40yo) with HIV in observational studies, but has not been studied in YLWH. Formative research by Taylor (PI), Nijhawan (Co-I), and Villarreal (Co-I) showed that patients and providers in Texas seek relational interventions and YLWH request mHealth approaches for engagement. We will use the Theory of Planned Behavior (TPB) as a theoretical model and Positive Youth Development (PYD) as an approach to rigorously adapt and pilot test a modified version of PL, PositiveLinks for Youth (PL4Y). To do so, we will conduct a rigorous formative evaluation of PositiveLinks to adapt it to the needs of YLWH, including: semi-structured interviews informed by TPB with YLWH experiencing challenges with care engagement and stakeholders, and feedback from a Youth Advisory Board (Aim 1). We will then develop and iteratively adapt components of PL and new youth-focused components emerging from the formative evaluation with YLWH who are newly diagnosed, disengaged in care, or not virologically suppressed using a human-centered design approach informed by PYD to generate PositiveLinks for Youth (PL4Y) (Aim 2). Finally, we will conduct a small pilot randomized control trial of the adapted PL4Y program in YLWH disengaged from or newly engaging in HIV care to assess its impact on virologic suppression (Aim 3). A mixed methods process evaluation will assess acceptability and feasibility of this novel intervention. Through these aims we will develop an innovative care engagement tool that caters to the developmental and socio/structural needs of YLWH. Our approach can serve as a model for efficient adaptation of mHealth interventions to new target audiences in response to an urgent community need.