Piloting an App-Based Just-in-Time Adaptive Ecological Momentary Intervention to Reduce Substance Use among HIV-Positive Sexual MinorityMen

试点基于应用程序的即时适应性生态瞬时干预措施，以减少艾滋病毒呈阳性的性少数男性的药物使用

• 批准号: 10731730
• 负责人: Brett M Millar
• 金额: $ 22.29万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10731730
• 关键词: Address; Affect; Applications Grants; Area; Bisexual; Buffers; Chronic Disease; Communities; Data; Data Collection; Dedications; Development; Drug usage; Effectiveness; Enrollment; Evidence based intervention; Feedback; Focus Groups; Gays; General Population; HIV; HIV Seropositivity; HIV risk; Health; Health Benefit; Heart Rate; Individual; Intercept; Intervention; Intervention Studies; Life; Link; National Institute of Drug Abuse; Notification; Outcome; Participant; Persons; Phase; Physiological; Population; Populations at Risk; Preparation; Prevention Research; Psychosocial Stress; Randomized; Randomized, Controlled Trials; Recreation; Research; Research Project Grants; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Sampling; Sexual Transmission; Stress; Surveys; Target Populations; Telephone; Testing; Time; United States; Update; Viral Load result; Work; acceptability and feasibility; adaptive intervention; biological adaptation to stress; community engaged research; comorbidity; craving; design; efficacy evaluation; evidence base; experience; improved; injection drug use; interest; intervention delivery; marginalization; medication nonadherence; mindfulness; mindfulness intervention; mobile application; multiphase optimization strategy; reduced substance use; response; sexual minority; sexual minority men; smart watch; social stigma; stress management; stress reduction; stressor; substance use; success; therapy design; transmission process; usability

ABSTRACT In the United States (U.S.), sexual minority men (SMM) are disproportionately affected by HIV compared to the general population. For this population, intersectional sexual minority and HIV-related stress add to general life stressors to increase health risks. Research demonstrates a bidirectional association between psychosocial stress and physiological HIV progression, including CD4 decline and increased viral load. However, stress is not only associated with HIV progression, it is also linked to transmission risk behaviors (TRB), such as medication non-adherence and substance use. Substance use is a particularly important risk factor for HIV transmission. In addition to injection drug use risk, recreational use is associated with sexual TRB and increased risk for HIV among SMM. As such, interventions which target stress responses may be particularly useful for HIV risk reduction among substance using SMM (SUSMM) living with HIV (LWH). Positive affect and mindfulness-based interventions have shown promise in reducing stress across various populations living with chronic illness, including HIV. However, despite the fact SMM represent a majority of the U.S. HIV+ population and SUSMM in particular experience prominent, unique stressors, few studies have examined these interventions and their potential health benefits for SUSMM-LWH. This R34 application builds on our pilot work in the areas of positive affect induction and mindfulness as potential intervention approaches to improve HIV-related health outcomes among SMM-LWH. In our proof-of-concept pilot (n=22), we adapted an integrative positive affect and mindfulness intervention for mobile app delivery. Our pilot findings suggest the mobile app is an acceptable and feasible delivery platform for SMM-LWH. However, SUSMM-LWH experience unique stressors (e.g. substance use stigma), and experience additional barriers to intervention. While the in-person version of this intervention demonstrated efficacy in a randomized control trial with SUSMM-LWH, we have yet to assess acceptability and feasibility for delivering it via mobile app with this population. We propose to first pilot our existing app-based intervention with a sample of SUSMM-LWH to gather community feedback, which will be used to tailor the app design and intervention content for the target population. In Phase 2, we will pilot a factorial optimization trial to assess acceptability and feasibility of two additional features that may enhance our just-in-time-adaptive ecological momentary intervention (EMI) design and delivery: (1) random craving prompts throughout the day in addition to a fixed, once-daily survey and (2) a smart watch in addition to our phone-based EMI. Data from this formative pilot will inform the development of subsequent research grant application to conduct a larger factorial optimization trail to assess how each of these new features (and their combination) impact the effectiveness of our intervention. This will be followed by a subsequent randomized control trial to evaluate efficacy of our optimized intervention, which will have a powerful and sustained effect on substance use and other HIV-related outcomes for SUSMM-LWH.

抽象的 在美国（美国），与艾滋病毒相比 普通人群。对于这个人群，交叉性少数群体和与HIV相关的压力增加了 一般生活压力源以增加健康风险。研究表明 社会心理应激和生理HIV进展，包括CD4下降和病毒载量增加。 但是，压力不仅与艾滋病毒的发展有关，还与传播风险行为有关 （TRB），例如药物不遵守和使用物质。吸毒是特别重要的风险 HIV传播的因素。除了注射药物使用风险外，娱乐使用与性有关 TRB和SMM中艾滋病毒的风险增加。因此，针对压力反应的干预措施可能是 使用HIV（LWH）的SMM（SUSMM）在物质中降低HIV风险特别有用。 积极的影响和基于正念的干预措施已显示出减轻各种压力的希望 患有慢性疾病的人群，包括艾滋病毒。但是，尽管事实是SMM代表的大多数 美国的艾滋病毒+人群和susmm尤其经验显着，独特的压力，很少有研究 检查了这些干预措施及其对SUSMM-LWH的潜在健康益处。此R34应用程序构建 随着潜在的干预方法，我们在积极影响归纳和正念领域的飞行员工作 为了改善SMM-LWH中与HIV相关的健康结果。在我们的概念验证飞行员（n = 22）中，我们改编了 移动应用程序交付的综合积极影响和正念干预。我们的飞行员发现建议 该移动应用程序是SMM-LWH的可接受且可行的交付平台。但是，susmm-lwh 体验独特的压力源（例如，使用污名），并经历了其他干预障碍。 虽然该干预措施的面对面版本在随机对照试验中证明了功效 SUSMM-LWH，我们尚未评估通过移动应用程序传递它的可接受性和可行性 人口。我们建议首先使用SUSMM-LWH样本进行我们现有的基于应用的干预措施 收集社区反馈，该反馈将用于定制目标的应用程序设计和干预内容 人口。在第2阶段，我们将尝试一项阶乘优化试验，以评估两个的可接受性和可行性 可能增强我们即时自适应生态瞬时干预（EMI）设计的其他功能 和交付：（1）除了固定的，每天一次的调查和（2）A外，全天随机提示 除了我们的基于电话的EMI外，智能手表。该形成性飞行员的数据将告知开发 随后的研究赠款申请，以进行更大的阶乘优化跟踪，以评估每个如何 这些新功能（及其组合）会影响我们干预的有效性。接下来是 随后的一项随后的随机对照试验，以评估我们优化干预的功效，该试验将具有 SUSMM-LWH对药物使用和其他与HIV相关的结果的强大和持续作用。