Comprehensive, tailored, technology-based intervention to improve virologic suppression among youth and young adults living with HIV

全面、量身定制、基于技术的干预措施，以改善艾滋病毒感染者的病毒抑制

• 批准号: 10693334
• 负责人: Parya Saberi
• 金额: $ 105.62万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693334
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adult; Age; Algorithms; Behavioral; Caring; Characteristics; Clinical; Collaborations; Communities; Continuity of Patient Care; Counseling; Data; Diagnosis; Economics; Epidemic; Event; Evidence based intervention; Face; Failure; Foundations; Friends; Geography; Goals; HIV; Health; Health Personnel; Health Professional; Healthcare; Home; Human Resources; Individual; Intervention; Life Expectancy; Logistics; Medication Management; Mental Health; Mental disorders; Methods; Mobile Health Application; Modeling; Morbidity - disease rate; Motivation; Outcome; Participant; Professional counselor; Provider; Quality of life; Randomized; Research; Resources; Risk; Service provision; Services; Social Workers; Social isolation; Substance Addiction; Technology; Testing; Theoretical model; Time; Training; Treatment Efficacy; Viral; Youth; age group; antiretroviral therapy; arm; barrier to care; community partnership; design; disability; efficacy testing; experience; forgetting; health care availability; health disparity; human centered design; human old age (65+); improved; innovation; mortality; primary outcome; randomized, clinical trials; responders and non-responders; skills; social stigma; socioeconomics; standard of care; substance use; substance use treatment; therapy adherence; transmission process; treatment arm; treatment services; treatment strategy; video chat; video coaching; young adult

Abstract/Project Summary: In the US, youth and young adults living with HIV (YLWH) have lower rates of antiretroviral therapy (ART) initiation, suboptimal ART adherence and retention in care, and higher rates of virologic failure, compared to older age groups. Additionally, there is an increased risk of substance dependence, psychiatric disorders, and mortality with increased risk of substance use at a younger age. Mental health (MH) and substance use (SU) impact every step of the HIV care continuum from diagnosis to viral suppression and exacerbate socioeconomic challenges of linkage and sustained access to healthcare. Given the strong evidence for the influence of MH and SU on poor HIV health outcomes, there is a clear need for increased access to and provision of these services. Despite the need to address these critical barriers to care in YLWH, there is a severe shortage of MH professionals nationwide and a lack of interventions tailored to this age group. In collaboration with the nonprofit AIDS Healthcare Foundation (the largest provider of HIV care) and a Youth Advisory Panel, the proposed study aims to address these barriers in a tailored manner using a differentiated care approach that is “youth-friendly.” Our goal is to test the effect of a tailored technology-based intervention in a randomized clinical trial (RCT) with an adaptive treatment strategy (ATS) among 200 YLWH (18–29 years old). The intervention includes: (1) brief weekly counseling sessions with a counselor to discuss MH, SU, HIV care engagement, and other barriers to care delivered via a video-chat platform, and (2) a mobile health application designed and developed using Human-Centered Design (HCD) with YLWH to address barriers to engagement in care. Individuals who are not virologically suppressed will be randomized to video- counseling+app or standard of care (SOC). Through this entirely remotely-conducted study, we will be able to: Aim 1: Test the efficacy of video-counseling+app vs SOC on virologic suppression in YLWH. We will compare HIV virologic suppression of those randomized to the intervention vs control arms at 16 weeks via an RCT. Aim 2: Assess the impact of video-counseling+app vs SOC on MH and SU in YLWH. We will evaluate the MH and SU differences between the intervention vs control arms at 16 weeks via an RCT. Aim 3: Explore an ATS to individualize the intervention by assigning the: (a) virologic “non-responders” in the intervention arm to intensified video-counseling+app for 16 more weeks, (b) virologic “responders” in the intervention arm to continue only app use for 16 more weeks. Therefore, in an era of severe shortages of MH providers when MH and SU challenges of YLWH are critical barriers to care, examining an innovative intervention developed using HCD with a differentiated care approach directed specifically to YLWH, grounded in a well-established theoretical model of care and formative research, and with community partnership is necessary for “getting to zero” and ending the HIV epidemic.

抽象/项目简介:

项目成果

iVY: protocol for a randomised clinical trial to test the effect of a technology-based intervention to improve virological suppression among young adults with HIV in the USA.

• DOI: 10.1136/bmjopen-2023-077676
• 发表时间: 2023-10-06
• 期刊: BMJ open
• 影响因子: 2.9