Improving engagement in care via Community-based mHealth Motivational Interviewing Tool for HIV-positive youth (COMMIT+)

项目摘要 在世界范围内，感染艾滋病毒的青年很少接受护理，健康状况也较差 比成年人做的更好。尽管如此，缺乏有效的干预措施来改善YLWH的 参与护理：保持门诊预约和坚持抗逆转录病毒治疗。干预措施 为解决这一问题，在很大程度上侧重于外部动机、激励措施和环境重新设计。 然而，社会心理学有令人信服的证据表明，内部，而不是外部， 激励因素与保持积极和健康的行为密切相关。 动机性面试（MI）已在世界各地使用，以提高客户的内部 这是改善包括艾滋病毒在内的许多疾病的护理参与的动力。同时，社区 卫生工作者已经证明有能力接触到脆弱的农村人口， 不太可能参与护理。然而，一个共同的发现是，没有持续的管理信息培训， 监督导致技能衰退，CHW返回到判断性的建议，这可能会疏远 YLWH。 在我们过去十年在尼泊尔和印度农村开展的工作的基础上，我们建议解决这些问题。 通过开发一个基于社区的艾滋病毒移动健康动机访谈工具， 积极青年（COMMIT+）。社区卫生工作者将使用COMMIT+来：1）获得决策支持， 社区中个别病例的MI，以及2）捕获客户同意的录音 与主管进行审查和反馈的互动，以便CHW能够在 初期训练。 在拟议的研究中，我们将开发、研究和完善COMMIT+，以便在未来进行多中心试验， 改善对YLWH的护理参与。我们将追求两个目标：1）发展社区- 艾滋病毒阳性青年的移动健康动机访谈工具（COMMIT+），以支持 社区卫生工作者使用和维持动机访谈技巧; 2）评估 社区卫生工作者、社区卫生工作者和他们的主管对社区卫生工作者承诺的可接受性和可行性， 抗逆转录病毒治疗的依从性、门诊预约和CD 4计数。以人为本 设计思维，我们将迭代开发COMMIT+，并在一个最高的网站上测试它。 尼泊尔艾滋病毒的发病率和流行率，以及社区卫生工作者已经使用移动的设备协助 临床任务。 在完成时，我们预计已经调整了COMMIT+，并证明了其可接受性， YLWH，CHW及其主管之间的可行性，并准备了申请 在尼泊尔和印度进行的多中心试验，MPI已经在那里工作了十多年。

Project Summary Worldwide, youth living with HIV (YLWH) are poorly engaged in care and have worse health outcomes than adults do. Despite this, there is a lack of effective interventions to improve YLWH's engagement in care: keeping clinic appointment and adhering to antiretroviral therapy. Interventions to address this have largely focused on external motivations, incentives, and environment redesign. However, there is compelling evidence from social psychology that internal, rather than external, motivators are strongly associated with maintenance of positive and healthy behaviors. Motivational Interviewing (MI) has been used around the world to enhance the client's internal motivation to improve care engagement for numerous diseases, including HIV. In parallel, Community Health Workers (CHWs) have demonstrated the capacity to reach vulnerable, rural populations, who are less likely to engage in care. However, a common finding is that MI training without ongoing supervision leads to skill decay, and CHWs return to judgmental advice-giving, which can alienate YLWH. Building on our work over the last ten years in rural Nepal and India, we propose to address these challenges by developing a Community-based mHealth Motivational Interviewing Tool for HIV- positive youth (COMMIT+). COMMIT+ will be used by CHWs to: 1) obtain decision-support to deliver MI for individual cases in the community, and 2) capture consented audio recordings of client interactions for review and feedback by their supervisors so CHWs can maintain MI skills beyond the initial training period. In the proposed study, we will develop, study, and refine COMMIT+ for a future multi-site trial to improve care engagement about YLWH. We will pursue two aims: 1) To develop the Community- based mHealth Motivational Interviewing Tool for HIV-positive youth (COMMIT+) to support community health workers in using and sustaining motivational interviewing skills; and 2) To assess the acceptability and feasibility of COMMIT+ among YLWH, CHWs, and their supervisors to improve adherence to antiretroviral therapy, clinic appointments, and CD4 counts. Using human-centered design thinking, we will iteratively develop COMMIT+ and test it at a site with one of the highest incidence and prevalence of HIV in Nepal, and where CHWs already use mobile devices to assist in clinical tasks. At completion, we expect to have adapted COMMIT+ and demonstrated its acceptability and feasibility among YLWH, CHWs, and their supervisors, and to have prepared an application for a multi-site trial in Nepal and India, where the MPIs have worked for over a decade.