Adapting mHealth interventions to improve self-management of HIV and substance use among emerging adults in Zambia

采用移动医疗干预措施，改善赞比亚新兴成年人对艾滋病毒和药物滥用的自我管理

• 批准号: 10813460
• 负责人: Karen MacDonell
• 金额: $ 24.74万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10813460
• 关键词: Acceleration; Address; Adherence; Adult; Affect; Africa South of the Sahara; Age; Alcohol consumption; Alcohols; Appointment; Behavior; Behavioral; Biological Markers; Caring; Clinic; Cognitive; Communities; Continuity of Patient Care; Counseling; Development; Disease; Dose; Drug usage; Effectiveness; Epidemic; Evidence based intervention; Focus Groups; Future; HIV; HIV Infections; HIV/AIDS; HIV/STD; Health; Health Personnel; Health behavior; Health system; Healthcare; Infection; Intervention; Interview; Link; Monitor; Motivation; NIH Program Announcements; Outcome; Patient Recruitments; Pattern; Persons; Pharmaceutical Preparations; Phase; Prevalence; Protocols documentation; Randomized; Resource-limited setting; Risk; Risk Behaviors; Risk Taking; Self Management; Services; Social Change; Social support; Substance abuse problem; System; Testing; Text Messaging; Treatment Efficacy; Viral Load result; Woman; Work; World Health Organization; Youth; Zambia; acceptability and feasibility; age group; alcohol and other drug; antiretroviral therapy; binge drinking; comorbidity; computerized; effective intervention; efficacy trial; emerging adult; emerging adulthood; feasibility research; group intervention; improved; innovation; intervention refinement; mHealth; marijuana use; medical appointment; medication compliance; men; mobile computing; motivational enhancement therapy; multi-site trial; multiphase optimization strategy; negative affect; participant retention; pilot test; pilot trial; post intervention; recruit; reduced substance use; response; satisfaction; sexual risk behavior; skills; social stigma; substance use; therapy adherence; therapy design; transmission process; usability

Sub-Saharan Africa is most severely affected by the HIV epidemic, particularly Zambia. Young people with HIV (YPWH) are disproportionately impacted by HIV/AIDS. Emerging adulthood (ages 18-24) is characterized by increasing independence, risk-taking behaviors, identity exploration, and changing social supports, which may impact HIV management behaviors, including medication adherence, retention in care, sexual risk behavior, and substance abuse. Substance use has synergistic and additive effects on health and HIV-related comorbidities, and accelerated HIV disease. Self-management interventions targeting HIV and substance use reduction in Zambian YPWH are urgently needed. We propose to develop and pilot a multi-component, mHealth intervention to promote HIV self-management and reduce substance use. We will adapt the 4- session, in-person Healthy Choices (HC) intervention for mHealth (mHC) to increase access and delivery of HC. In addition, we will develop and pilot test Motivational Text Messaging (MTM) to enhance the impact of mHC. mHC and MTM will be delivered using Computerized Intervention Authoring System (CIAS). Our primary aim is to develop and assess the preliminary efficacy of the resulting mHealth intervention. We will utilize a Multiphase Optimization Strategy (MOST) framework to identify the most effective intervention component or combination of components that addresses self-management and substance use among YPWH in Zambia. The proposed study includes 3 phases. Phase I includes focus groups with Zambian YPWH to explore barriers and facilitators of HIV self-management and substance use to inform the intervention. Phase II consists of adapting and beta testing of mHC and MTM for functionality and feasibility using a community advisory board of Zambian YPWH, local healthcare personnel, and community leaders. In Phase III, we will conduct a pilot using the MOST framework to assess feasibility, acceptability, and preliminary efficacy of intervention components (mHC and MTM) to improve HIV self-management and reduce alcohol and other drug use. One hundred YPWH be randomized to four experimental conditions: 1) Standard ART Counseling (SAC), 2) mHC + SAC, 3) MTM + SAC, and 4) mHC + MTM + SAC. Feasibility and acceptability of the intervention will be assessed through paradata of usage patterns and the System Usability Scale. Preliminary impact will be assessed by evaluating ART Adherence and substance use. YPWH will complete assessments at baseline and 3-, and 6-months post-intervention. Biomarkers of adherence to ART and HIV/STI will be collected. Upon project completion, we will have an optimized mHealth intervention to support YPWH’s self- management of HIV which will be ready for testing in a larger efficacy trial.

撒哈拉以南非洲受艾滋病毒流行病的影响最严重，特别是赞比亚。的年轻人 艾滋病毒/艾滋病对艾滋病毒（YPWH）的影响不成比例。成年初显期（18-24岁）的特点是 通过增加独立性，冒险行为，身份探索和改变社会支持， 可能影响艾滋病毒管理行为，包括药物依从性，护理保留，性风险 行为和药物滥用药物使用对健康和艾滋病毒相关的健康和健康具有协同和累加效应。 合并症和加速的HIV疾病。针对艾滋病毒和药物使用的自我管理干预措施 减少赞比亚YPWH是当务之急。我们建议开发和试验一个多组成部分， 移动健康干预措施，以促进艾滋病毒自我管理和减少药物使用。我们将调整4- 会议，针对移动健康（mHC）的面对面健康选择（HC）干预，以增加获得和提供 嗯。此外，我们将开发和试点测试动机短信（MTM），以提高 MHC。MHC和MTM将使用计算机化干预创作系统（CIAS）递送。我们 主要目的是开发和评估由此产生的移动健康干预措施的初步疗效。我们将 利用多阶段优化战略（MOST）框架确定最有效的干预措施 一个或多个部分，以解决青年工作坊的自我管理和药物使用问题 在赞比亚。拟议的研究包括三个阶段。第一阶段包括与赞比亚YPWH的焦点小组， 探讨艾滋病毒自我管理和药物使用的障碍和促进因素，为干预提供信息。相 II包括使用社区对MHC和MTM的功能和可行性进行调整和beta测试 赞比亚YPWH咨询委员会、当地医疗保健人员和社区领袖。在第三阶段，我们将 利用社会变革管理计划框架开展试点，评估以下项目的可行性、可接受性和初步成效： 干预成分（MHC和MTM），以改善艾滋病毒自我管理和减少酒精和其他 吸毒将100名YPWH随机分为四个实验条件：1）标准ART咨询 (SAC)2）mHC + SAC，3）MTM + SAC，和4）mHC + MTM + SAC。可行性和可接受性 干预将通过使用模式和系统可用性量表进行评估。初步 将通过评估ART依从性和物质使用来评估影响。毅进医院将于 基线和干预后3个月和6个月。坚持抗逆转录病毒疗法和艾滋病毒/性传播感染的生物标志物将 收集。在项目完成后，我们将有一个优化的mHealth干预，以支持YPWH的自我- 这将准备在一个更大的疗效试验中进行测试。