A mobile phone intervention using a relational human talking Avatar to promote multiple stages of the HIV Care Continuum in African American MSM

摘要：HIV阳性的非裔美国男性与男性发生性行为(AAMSM)的比例最低 保留在护理中的百分比，并且不太可能有病毒抑制，这一结果取决于 坚持抗逆转录病毒疗法(ART)。这项建议侧重于创新的理论驱动的干预 旨在帮助改善AAMSM的结果，目标是艾滋病毒护理连续3个阶段，(1)保留， (2)坚持抗逆转录病毒药物治疗；(3)病毒抑制。我的个人健康指南是 创新的对话关系型人类阿凡达移动电话应用程序，使艾滋病毒阳性的AAMSM参与 坚持和保留在护理中。这款应用程序的开发是受信息动机的启发 行为技能模型，关注影响个人行为的信息和动机之间的反馈 行为技能、行为和期望的健康结果。在用户的家中或他们的任何地方的隐私中 有了手机，阿凡达就可以鼓励健康的行为，承认耻辱，并以同理心说话， 以听觉方式教育低识字率的人，使用可信的文化上合适的措辞，并邀请用户 听取其他艾滋病毒阳性患者及其照顾者的建议和励志故事。一项关于艾滋病毒的初步研究-- 积极的AAMSM年龄在18-34岁之间，表现出可接受性、对应用程序的热情和初步 功效。作为UIC、埃默里大学和密西西比医学大学合作的一部分 中心，我们建议测试我的个人健康指南阿凡达应用程序对年轻艾滋病毒的有效性- AAMSM阳性。在这项为期5年的研究中，应用程序将根据试点数据(目标1)进行改进，然后是250 18-34岁、可检测到病毒载量的艾滋病毒阳性AAMSM将被随机抽样 到我的个人健康指南阿凡达应用程序或食品安全阿凡达应用程序控制干预 6个月期间(目标2)。无线监测的抗逆转录病毒治疗依从性将收集1个月的基线和 然后，无线监测ART依从性、病毒载量和诊所预约数据将在整个过程中收集 6个月的随访期。我们假设，我的个人健康指南干预措施的参与者 在接下来的治疗中，ART依从性、病毒载量和护理保留率将有显著改善 与对照组受试者相比，受试者处于上升周期。我们还将确定符合以下条件的手机应用程序功能 与改进遵守情况有关，以便为改进申请提供信息(目标3)。我们 假设更频繁地使用包括激励信息的阿凡达信息功能将是 与提高艺术忠诚度有关。这项提议具有创新性，因为它在 针对年轻AAMSM的预防和治疗研究，AAMSM是治疗失败和 在护理中保持不佳，通过在手机中使用关系对话的人类化身来克服 参与临床护理方面的耻辱和识字。如果我的个人健康指南干预是 如果被证明是有效的，它可能会迅速扩大规模，以便广泛传播。

ABSTRACT: HIV-positive African American men who have sex with men (AAMSM) have the lowest percentage of retention in care and are less likely to have viral suppression, an outcome that relies on antiretroviral therapy (ART) adherence. This proposal focuses on an innovative theory-driven intervention aimed at helping to improve outcomes for AAMSM targeting 3 stages of the HIV Care Continuum, (1) retention, (2) adherence to antiretroviral medication, and (3) viral suppression. My Personal Health Guide is an innovative talking relational human Avatar mobile phone application to engage HIV-positive AAMSM in adherence and retention in care. Development of this app was informed by the Information Motivation Behavioral Skills Model that focuses on feedback between information and motivation that affect one's behavioral skills, behaviors, and desired health outcomes. In the privacy of the user's home or anywhere they have their phone, the Avatar can encourage healthy behavior, acknowledge stigma and speak with empathy, audibly teach persons with low literacy, employ credible culturally appropriate phrasing, and invite the user to hear advice and motivational stories of other HIV-positive people and their caregivers. A pilot study in HIV- positive AAMSM ages 18-34 years demonstrated acceptability, enthusiasm for the app, and preliminary efficacy. As part of a collaboration between UIC, Emory University, and the University of Mississippi Medical Center, we propose to test the efficacy of the My Personal Health Guide Avatar application for young HIV- positive AAMSM. In this 5-year study, the application will be refined based on pilot data (Aim 1) and then 250 HIV-positive AAMSM between the ages of 18-34 years with detectable viral load at baseline will be randomized to the My Personal Health Guide Avatar application or a food safety Avatar application control intervention for a 6-month period (Aim 2). Wirelessly monitored ART adherence will be collected for 1-month at baseline and then wirelessly monitored ART adherence, viral load, and clinic appointment data will be collected throughout the 6-month follow-up period. We hypothesize that participants in the My Personal Health Guide intervention will demonstrate significant improvements in ART adherence, viral load, and retention in care during the follow- up period compared to control participants. We will also identify mobile phone application functions that are associated with improvement in adherence in order to inform refinement of the application (Aim 3). We hypothesize that more frequent use of Avatar information functions that included motivational messages will be associated with improved ART adherence. This proposal is innovative in that it launches a new direction in prevention and treatment research for young AAMSM, a population at increased risk for therapeutic failure and poor retention in care, by using a relational talking human Avatar in a mobile phone to overcome the impact of stigma and literacy on engagement with clinical care. If the My Personal Health Guide intervention is demonstrated to be effective, it may be quickly scaled up for wide-scale dissemination.