Tough Talks: A Disclosure Intervention for HIV+ YMSM

项目总结 男男性行为者(MSM)占美国所有新增艾滋病毒感染者的近三分之二 (美国)和年轻男男性接触者(YMSM)是艾滋病毒发病率显著增加的唯一风险群体。 在年轻人中，67%的人报告没有向第一次性伴侣透露。4披露自己的艾滋病毒状况是 对于获得支持很重要，这可以提高药物依从性和护理保留率。 那些透露的人更有可能与未感染的性伴侣和数学模型一起使用避孕套 估计增加对性伴侣的艾滋病毒状况披露可能会减少40%-60%的传播。 此外，披露信息可能会激励未受感染的性伴侣寻求检测并减少他们自己的艾滋病毒 传播行为。鉴于与披露相关的潜在好处和挑战，有必要 对于复杂的干预措施，可以帮助MSM，与披露过程。虚拟现实提供了一种 独特的环境，为用户实践艾滋病毒披露。人工智能(AI)驱动的披露可能会提供 通过使用代表潜在浪漫的现实化身，比面对面角色扮演更具优势 合作伙伴，以及用户预期进行披露对话的概率设置。用户拥有 有机会练习披露，并体验各种回应和结果。在此过程的第一阶段 我们开发了一个基于iPad的虚拟现实系统，它具有三个化身，两个虚拟地点和 代表各种常见披露经验和背景的三种披露情景 YMSM经历过的。在第二阶段，我们将进一步加强艰难的谈判，并开发全功能自动化 通过新创建的中心通过多站点随机对照试验(RCT)进行测试的版本 跨预防和护理连续体的创新技术(ITech)，这是一个由NIH资助的支持中心 青少年艾滋病毒研究。这一第二阶段SBIR的目标是：1)完善和加强目前的艰难谈判 披露场景，包括额外的内容、角色和虚拟环境。形成性工作 YMSM(16-29岁)将为开发提供信息，我们将与人工智能软件领域的领先者合作，将 将自然语言融入人工智能驱动的场景中；2)制定强硬的谈话单机干预。这完全是 自动干预将包括在AIM 1中创建的人工智能驱动的披露场景以及虚拟 披露教练指导参与者通过干预目标设定互动练习和互动 教育视频。在开发之后，将进行技术试点以优化功能和技术 将用8-10个YMSM进行表演；3)进行三臂综合功效/效果 比较在线提供的干预(ARM 1)与诊所提供的干预(ARM 2)与标准 仅关怀(SOC)披露报文。HIV病毒载量和无套肛交的主要结局 在干预结束时(1个月)和6个月随访时评估(CAI)。我们会估计 避免了传输和每个ARM的计划成本(19-36个月)。

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).