LetSync: An mHealth approach to HIV care engagement among black men in couples

项目摘要/摘要 根据目前的诊断率，每两个与男性发生性行为的黑人男性中就有一个将被诊断为 在他们的有生之年感染艾滋病毒。优化护理保留和坚持抗逆转录病毒治疗的干预措施 迫切需要在BMSM中开展抗逆转录病毒药物治疗，以减少艾滋病毒的种族差异。二元干预方法有 很有希望，因为近一半的BMSM艾滋病毒携带者是在初级关系中，并且符合 呼吁对BMSM进行研究，把重点放在个人层面之外。我们对BMSM的初步研究 夫妻发现，主要关系往往是满足艾滋病毒护理需求的主要来源 订婚。BMSM夫妇参与共同解决问题和协调护理的工作 围绕治疗和护理同步和共同组织时间表、活动和行为。我们也 研究发现，护理投入中的二元协调和联合解决问题可能在 BMSM夫妇具有更强的韧性，定义为夫妻克服共同逆境的能力 这对BMSM健康和福祉的社会和结构性因素的压力起到了缓冲作用。基于我们的 在前期工作和现有研究的基础上，我们开发了一个二元HIV关怀参与的理论框架 来指导这项研究。智能手机在不同年龄和社会经济背景的BMSM中无处不在 背景，移动健康技术(MHealth)与艾滋病毒一样可行、可接受和有效 BMSM人群的干预措施。我们已经开发了针对BMSM夫妇的干预的初步设计 应用程序(APP)，LetSync，以提高护理中的保留率和对ART的依从性。BMSM夫妇表现得很好 对这种方法感兴趣。然而，关键问题仍然存在，例如需要更深入地了解如何 二元过程与增强二元能力、它们在移动健康干预中如何成为目标、 以及对试点干预组件和特征的需求。因此，R01的目标如下所示。 目标1将涉及调查艾滋病毒护理参与中相互关联的二元过程(夫妻的复原力，联合 通过对12名血清一致性阳性的BMSM进行深入访谈，解决问题，进行二元协调 在我们的概念框架指导下，12对血清不一致夫妇(24对，N=48)。目标2将开发一种 夫妇的mHealth干预由Aim 1和我们之前的mHealth设计提供信息，通过迭代应用程序 通过BMSM夫妇的社区咨询委员会和应用程序原型的迷你试点进行开发， 干预方案和程序。目标3将需要一项随机的、等待名单控制的试点试验，共有80人 夫妇(N=160)，评估其可接受性、可行性和对护理和ART保留的初步影响 通过头发中的抗逆转录病毒浓度来衡量粘附性。这项拟议研究的发现是 为随后的全面随机对照试验提供信息以测试LetSync在改善艾滋病毒护理和 BMSM夫妇的治疗结果有助于减少美国艾滋病病毒的种族差异。

PROJECT SUMMARY/ABSTRACT Based on current diagnoses rates, one in two Black men-who-have-sex-with-men (BMSM) will be diagnosed with HIV during their lifetime. Interventions to optimize retention in care and adherence to antiretroviral therapy (ART) among BMSM are urgently needed to reduce HIV racial disparities. Dyadic intervention approaches are promising, given that nearly half of BMSM living with HIV are in primary relationships, and are consistent with calls for research with BMSM to focus beyond the individual level. Our preliminary research with BMSM in couples finds that the primary relationship is often the main resource in meeting needs in HIV care engagement. BMSM couples engage in joint problem-solving and dyadic coordination of care that entail synchronizing and co-organizing schedules, activities, and behaviors around treatment and care. We also found that dyadic coordination and joint problem-solving in care engagement may be more common among BMSM couples with greater couple’s resilience, defined as the couple’s capacity to overcome shared adversity that buffers against the strains of social and structural factors on health and wellbeing for BMSM. Based on our preliminary work and extant research, we developed a theoretical Framework of Dyadic HIV Care Engagement to guide this research. Smartphones are ubiquitous among BMSM of various ages and socioeconomic backgrounds, and mobile technology for health (mHealth) is feasible, acceptable, and effective as HIV interventions among BMSM. We have developed initial designs for a BMSM-couple-focused intervention application (app), LetSync, to improve retention in care and ART adherence. BMSM couples showed a great interest in this approach. However, critical issues remain, such as the need for a deeper understanding of how dyadic processes interrelate to bolster dyadic capacity, how they may be targeted in an mHealth intervention, and the need for piloting intervention components and features. As such, the aims to this R01 are as follows. Aim 1 will involve investigating interrelated dyadic processes in HIV care engagement (couple’s resilience, joint problem-solving, dyadic coordination) through in-depth interviews with BMSM in 12 seroconcordant-positive and 12 serodiscordant couples (24 couples, N=48) guided by our conceptual framework. Aim 2 will develop a couple’s mHealth intervention informed by Aim 1 and our prior mHealth designs, through iterative app development with a community advisory council of BMSM couples and a mini-pilot of the app prototype, intervention protocols, and procedures. Aim 3 will entail a randomized, waitlist-controlled pilot trial with 80 couples (N=160) to assess its acceptability, feasibility, and preliminary impact on retention in care and ART adherence as measured by antiretroviral concentrations in hair. Findings from the proposed research are critical for informing a subsequent full-scale RCT to test the efficacy of LetSync in improving HIV care and treatment outcomes among BMSM couples toward reducing HIV racial disparities in the U.S.