Development and Testing of a Mobile Application to Enhance HIV Prevention Cascade in Malaysian MSM

开发和测试移动应用程序以加强马来西亚男男性接触者的艾滋病毒预防级联

• 批准号: 10673162
• 负责人: Roman Shrestha
• 金额: $ 29.46万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673162
• 关键词: AIDS prevention; Acceleration; Achievement; Acquired Immunodeficiency Syndrome; Address; Adherence; Amphetamines; Asia; Benchmarking; Caring; Cellular Phone; Client; Clinic; Counseling; Country; Decision Making; Development; Discrimination; Disparity; Drug usage; Epidemic; Face; Focus Groups; Fright; Guide prevention; HIV; HIV Infections; Health; Health Personnel; Health Professional; Health Services; Healthcare; Homosexuality; Human immunodeficiency virus test; Hybrids; Implementation readiness; Incidence; Income; Institution; Intervention; Interview; Laws; Learning; Link; Malaysia; Malaysian; Measures; Mental Depression; Mental Health; Mental disorders; Modeling; Motivation; Muslim population group; Outcome; Patients; Persons; Phase; Population; Prevalence; Prevention; Provider; Psyche structure; Psychoses; Recommendation; Research; Research Personnel; Risk Assessment; Risk Behaviors; Services; Sexual Health; Sexual Transmission; Sexuality; Sexually Transmitted Diseases; Statutes and Laws; Stigmatization; Strategic Planning; Study models; Substance Use Disorder; Technology; Testing; Translating; Universities; Unsafe Sex; care systems; clinical care; cost effective; depressive symptoms; design; efficacy evaluation; efficacy outcomes; efficacy testing; evidence base; health care delivery; health disparity; health management; high risk; implementation outcomes; implementation science; improved; innovation; insight; integrated care; interest; low and middle-income countries; mHealth; men; men who have sex with men; mobile application; mortality; overtreatment; pre-exposure prophylaxis; preference; prevention practice; prevention service; preventive intervention; prospective test; prototype; provider communication; psychiatric comorbidity; research and development; response; scale up; screening; sex; social stigma; southeast Asian; stakeholder perspectives; stimulant use; substance use; suicidal; syndemic; treatment as usual; uptake; usability; virtual

Abstract Malaysia’s HIV epidemic is rapidly expanding with recent evidence suggesting accelerated sexual transmission, especially in MSM: 10% in 2008 to 54% in 2016. Evidence suggests high HIV prevalence in MSM being nationally (21.6%) and in Kuala Lumpur (43%). Central to this expanding HIV epidemic in MSM is condomless sex, STIs, and co-occurring psychiatric and substance use disorders (P/SUD), especially depression and amphetamine-type stimulant (ATS) use. Insights into Malaysia’s HIV prevention gap are multi-factorial. Both homosexuality and substance use is criminalized in Malaysia, making MSM bear the dual burden of stigma and discrimination, including in healthcare, which promotes P/SUD disparities in MSM. MSM are often hesitant to disclose their sexuality, risk behaviors or depressive symptoms, mostly due to fear of stigma, discrimination, or criminalization. Stigma and discrimination are also enacted on MSM by healthcare providers resulting in extraordinary health disparities and low prevention uptake. Strategies that facilitate screening and prevention practices in a non-judgmental fashion are likely to increase access to evidence-based prevention like HIV testing and pre-exposure prophylaxis (PrEP), especially if screening and counseling addresses P/SUD. Introducing an innovative app-based platform to deliver holistic HIV prevention services represents a paradigm shift in HIV prevention since it can deliver effective prevention in a confidential, less-stigmatizing and convenient manner. Building on the advantages for scalability and dissemination afforded using app platform, we propose to develop and test the efficacy of a clinic-affiliated app (myCareLink) to deliver an integrated HIV prevention intervention that will promote HIV testing and linkage to PrEP and incorporates screening and support for underlying P/SUD in Malaysian MSM. The design of this study will take place in 2 phases. The R21 phase will consist of 2 stages: 1) We will adapt, expand and refine an existing app, which will be integrated within the existing clinical care system. First, we will conduct focus groups with MSM (n=25) and stakeholders (n=10) to theater test the existing app to develop an interactive prototype of the myCareLink app (alpha version). Then, the prototype will undergo usability testing (n=20), followed by the full development of the app (beta version); 2) Expanded Beta testing (n=50) of the myCareLink app will assess its usability and acceptability. The R33 phase will involve conducting a Type 1 Hybrid Implementation Science Trial to evaluate the efficacy of myCareLink app vs. treatment as usual (TAU) in 268 Malaysian MSM for primary (HIV testing and PrEP uptake) and secondary (PrEP adherence and persistence) efficacy outcomes. Multi-level implementation outcomes will involve stakeholders’ perspective of the relative advantage of myCareLink app over TAU, adaptability, perceived design quality and packaging, compatibility in the Malaysian context, interest in sharing the app with others and readiness for implementation. Research capacity strengthening between Yale and the University of Malaya will occur through collaborative learning between researchers at both institutions to promote expansion of mHealth research.

摘要 马来西亚艾滋病毒流行正在迅速扩大，最近的证据表明，性行为加速 传播，特别是在男男性接触者中：2008年为10%，2016年为54%。有证据表明男男性接触者中艾滋病毒感染率很高 在全国(21.6%)和吉隆坡(43%)。男男性同性恋者中艾滋病毒流行不断扩大的核心是 无公寓性行为、性传播感染以及精神和物质使用障碍(P/SUD)，尤其是抑郁症 以及苯丙胺类兴奋剂(ATS)的使用。对马来西亚艾滋病毒预防差距的洞察是多因素的。 在马来西亚，同性恋和吸毒都被定为犯罪，这使得男男性接触者背负着污名的双重负担 以及歧视，包括在医疗保健方面，这促进了男男性接触者中P/SUD的差异。MSM经常犹豫不决 披露他们的性取向、危险行为或抑郁症状，主要是由于害怕耻辱、歧视、 或定为刑事犯罪。医疗保健提供者也对男男性接触者实施耻辱和歧视，导致 巨大的健康差距和较低的预防覆盖率。促进筛查和预防的战略 非评判方式的做法可能会增加艾滋病毒检测等循证预防的机会 暴露前预防(PrEP)，特别是在筛查和咨询解决P/SUD的情况下。介绍 基于应用程序的创新平台提供全面的艾滋病毒预防服务，代表着艾滋病毒的范式转变 预防，因为它可以以保密、不那么污名化和方便的方式提供有效的预防。 基于使用APP平台提供的可扩展性和传播性优势，我们建议开发 并测试附属于诊所的应用程序(MyCareLink)提供综合艾滋病毒预防干预的有效性 这将促进艾滋病毒检测和与PrEP的联系，并纳入对潜在P/SUD的筛查和支持 在马来西亚的MSM。本研究的设计将分两个阶段进行。R21阶段将包括两个阶段：1) 我们将对现有的APP进行调整、扩展和完善，将其整合到现有的临床医疗体系中。 首先，我们将与MSM(n=25)和利益相关者(n=10)一起进行焦点小组，以在大区测试现有应用程序 开发一个交互式的myCareLink应用程序原型(Alpha版)。然后，原型将经历 可用性测试(n=20)，随后全面开发应用程序(测试版)；2)扩展测试版测试 (n=50)的myCareLink应用程序将评估其可用性和可接受性。R33阶段将涉及到 一项评估myCareLink应用程序与常规治疗效果的1型混合实施科学试验 (Tau)对268名马来西亚男男性接触者进行初级(艾滋病毒检测和PrEP吸收)和继发性(PrEP依从性和 持久性)疗效结果。多层次的执行成果将涉及利益攸关方对 MyCareLink应用程序相对于TAU的相对优势、适应性、可感知的设计质量和包装， 马来西亚背景下的兼容性、与其他人共享应用程序的兴趣以及实施的准备情况。 耶鲁大学和马来亚大学将通过合作加强研究能力 两个机构的研究人员之间的学习，以促进移动健康研究的扩展。