Tough Talks: A Disclosure Intervention for HIV+ YMSM

艰难的谈话：针对 HIV YMSM 的披露干预措施

• 批准号: 9348065
• 负责人: Margo Adams Larsen
• 金额: $ 53.07万
• 依托单位: VIRTUALLY BETTER, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9348065
• 关键词: Adherence; Adolescent; Anti-Retroviral Agents; Anus; Artificial Intelligence; Behavior; Caring; Clinic; Complex; Computer software; Continuity of Patient Care; Development; Disclosure; Environment; Exercise; Family; Fright; Funding; Goals; HIV; HIV Infections; HIV Seropositivity; Human Resources; Human immunodeficiency virus test; Incidence; Individual; Intervention; Lead; Location; Mediation; Mental Health; Nature; Newly Diagnosed; Outcome; Participant; Performance; Persons; Phase; Play; Prevention; Process; Randomized Controlled Trials; Reporting; Research; Risk; Role; Services; Sexual Partners; Site; Small Business Innovation Research Grant; Social Network; System; Technology; Testing; Time; United States; United States National Institutes of Health; Viral Load result; Work; Youth; aged; arm; base; condoms; cost; cost effective; eHealth; effectiveness trial; experience; follow-up; improved; innovative technologies; mathematical model; medication compliance; member; men who have sex with men; natural language; primary outcome; programs; response; scale up; sex; social stigma; standard of care; systematic review; technology development; therapeutic development; tool; transmission process; virtual; virtual reality; young men who have sex with men

PROJECT SUMMARY Men who have sex with men (MSM) account for nearly two-thirds all of new HIV infections in the United States (US) and young MSM (YMSM) are the only risk group experiencing a significant increase in HIV incidence. Among youth, 67 percent report not disclosing to their first time sex partners.4 Disclosing of one’s HIV status is important for accessing support which can lead to improved medication adherence and retention in care. Those who disclose are more likely to use condoms with uninfected sex partners5 and mathematical modeling estimates that increased HIV status disclosure to sex partners may reduce transmissions by 40-60%.6,7 Further, disclosure may motivate uninfected sex partners to seek testing and reduce their own HIV transmission behaviors. Given the potential benefits and challenges associated with disclosure, there is a need for sophisticated interventions that can assist MSM, with the disclosure process. Virtual reality provides a unique environment for users to practice HIV disclosure. Artificial intelligence (AI) driven disclosure may offer advantages over in-person role play through the use of realistic avatars that represent potential romantic partners, and probabilistic settings where users envision having disclosure conversations. Users have the opportunity to practice disclosing and experience a variety of responses and outcomes. During Phase I of this project we developed an iPad based virtual reality system that features three avatars, two virtual locations and three disclosure scenarios which represent a variety of common disclosure experiences and contexts experienced by YMSM. In Phase II we will further enhance Tough Talks and develop a full-feature automated version to test via a multi-site, randomized controlled trial (RCT) through the newly created Center for Innovative Technologies (iTech) across the Prevention and Care Continuum, an NIH-funded center to support adolescent HIV research. The aims of this Phase II SBIR are: 1) Refine and enhance the current Tough Talks disclosure scenarios to include additional content, characters and virtual environments. Formative work with YMSM (aged 16-29 years) will inform development and we will work with a leader in AI software to incorporate natural language into the AI driven scenarios; 2) Develop the Tough Talks stand-alone intervention. This fully automated intervention will include the AI driven disclosure scenarios created in aim 1 as well as a virtual disclosure coach to guide participants through the intervention goal-setting interactive exercises and interactive educational videos. Following development, a technical pilot to optimize functionality and technical performance will be conducted with 8-10 YMSM and; 3) Conduct a three-arm combined efficacy/effectiveness trial to compare the intervention delivered online (Arm 1) versus in the clinic (Arm 2) compared to standard of care (SOC) disclosure messaging only. Primary outcomes of HIV viral load and condomless anal intercourse (CAI) will be assessed at intervention completion (1 month) and at 6-month follow-up. We will estimate transmissions averted and program costs of each arm (Months 19-36).

项目总结