A mobile phone short message service intervention to increase retention in HIV care among HIV-positive men who have sex with men in Peru (WelTel Peru)

摘要 保留艾滋病毒护理与更长的生存期、病毒抑制和较低的艾滋病毒传播率有关。艾滋病病毒 不成比例地影响男男性行为者(MSM)。在秘鲁，艾滋病毒流行集中在 他们(患病率为12.2%)，而一般人口中只有0.4%是艾滋病毒+。令人担忧的是，感染艾滋病毒的男男性同性恋者 不太可能继续从事护理工作！而不是其他人口群体。对男男性接触者的研究已经报道了 重新检测艾滋病毒和其他性传播感染的短信(短信)提醒。然而，更多 需要对他们进行试验，以评估使用SMS来增加资源中艾滋病毒护理的保留率。 有限的设置，例如在拉丁美洲。双向文本消息传递可以提供更高级别的实时 对病人的支持。Weltel是第一个使用交互式双向文本的随机对照试验 报告自我报告的遵从性和病毒抑制显著增加的消息传递方法。这个 这项研究的假设是，Weltel的升级版本提供了基于短信的交互式双向 干预措施将增加秘鲁艾滋病毒/男男性接触者中的护理保留率。这一职业发展奖旨在： 1)开发基于短信的干预措施，通过Weltel系统提供，以增加在 在秘鲁一家政府医院对艾滋病毒阳性男男性接触者进行艾滋病毒护理；以及2)确定 与标准护理相比，增加艾滋病毒护理保留率的干预措施。我会招募208人 HIV+MSM，并将他们(1：1)随机分为干预组(接受基于短信的干预)和对照组 (护理标准)组。我将在12个月的课程期间对他们进行跟踪调查。主 结果将是在注册后一年内保留艾滋病毒护理。结果将被用来设计多个 现场试验，评估干预措施在改善HIV+患者保留艾滋病毒护理方面的有效性 秘鲁男男性接触者将提交R01资助。一个多学科的指导团队将为我提供支持 与我的职业规划相关的领域的专业知识：艾滋病毒预防试验(Duerr博士)、移动保健(Blas博士和Dr.Blas博士) 、艾滋病毒研究(冈萨雷斯博士)、实施科学(赞特博士)、定性研究(加利亚博士)、 量化方法(Carcamo博士)和干预措施评估(Garcia博士)。和他们一起，我设计了一个 培训计划，以填补知识和技能的空白，我需要成功地实现我的目标。我将获得额外的正式 定性研究和实施科学方面的培训，以及！统计学和流行病学方法。这就做 我还将获得赠款/手稿写作方面的技能，并将继续接受负责任的行为培训 研究。这种有指导的研究培训支持将使我能够实现我成为领先的 佩鲁亚纳·卡耶塔诺·赫雷迪亚大学全球卫生研究员，积极与国际顶尖 机构，并以严格的证据促进卫生政策。

Summary Retention in HIV care is associated with longer survival, viral suppression, and lower HIV transmission. HIV disproportionally affects men who have sex with men (MSM). In Peru, the HIV epidemic is concentrated among them (prevalence 12.2%), while only 0.4% of the general population is HIV+. Worryingly, MSM with HIV are less likely to stay engaged in care! than other population groups. Studies with MSM have reported efficacy of text-message (SMS) reminders for retesting of HIV and other sexually transmitted infections. However, more trials are needed with them in order to assess the use of SMS for increasing retention in HIV care in resource- limited settings, such as in Latin America. Two-way text messaging can provide an increased level of real-time support to patients. WelTel was the first randomized controlled trial using an interactive two-way text messaging approach that reported a significant increase in self-reported adherence and viral suppression. The hypothesis for this study is that an upgraded version of WelTel to deliver an interactive two-way SMS-based intervention will increase retention in care among HIV+ MSM in Peru. This career development award seeks: 1) to develop an SMS-based intervention to be delivered through the WelTel system to increase retention in HIV care among HIV-positive MSM at a government-based hospital in Peru; and 2) to determine the efficacy of the intervention for increasing retention in HIV care when compared with standard-of-care. I will recruit 208 HIV+ MSM and randomize them (1:1) to an intervention (receives the SMS-based intervention) and control (standard of care) group. I will follow them up throughout the duration of the twelve months course. The main outcome will be retention in HIV care within one year after enrollment. Results will be used to design a multi- site trial to assess the effectiveness of the intervention in improving retention in HIV care among HIV+ Peruvian MSM that will be submitted for R01 funding. A multi-disciplinary mentoring team will support me with expertise in areas related to my career plan: HIV prevention trials (Dr. Duerr), mobile health (Dr. Blas and Dr. Lester), HIV research (Dr. Gonzales), implementation science (Dr. Zunt), qualitative research (Dr. Galea), quantitative methods (Dr. Carcamo), and evaluation of interventions (Dr. Garcia). With them, I have designed a training plan to fill the gaps in knowledge and skills I need to succeed in my goals. I will obtain additional formal training in qualitative research and implementation science, and! statistical and epidemiological methods. I will also acquire skills in grant/manuscript writing and I will pursue continuous training in responsible conduct of research. This mentored research training support will enable me to achieve my goal of becoming a leading global health researcher at Universidad Peruana Cayetano Heredia, actively collaborating with top international institutions and fostering health policies with rigorous evidence.