Integration of Peer Navigation and mHealth Technology to Improve Viral Suppression among Racial and Ethnic Minority PLWH in Community-Based HIV Care Clinics

点击翻译按钮获取中文摘要

PROJECT SUMMARY Significant disparities continue to exist in the HIV care continuum in the U.S., with Hispanic and Black persons living with HIV (HBPLH) being less likely to achieve viral suppression compared to non-Hispanic White persons living with HIV. The same HIV treatment disparities exist in San Diego County, one of the focal counties under the Ending the HIV Epidemic Initiative. Disparities are exacerbated by co-occurring syndemic conditions, including substance use. Peer navigators, as one type of community health worker, have been shown to play meaningful roles to support PLH to stay engaged in care in developing countries. More rigorous studies are needed to evaluate the impact of peer navigators on the HIV care continuum in the U.S. While peer navigators may promote positive outcomes among PLH, scale-up of the traditional peer navigation approach is difficult in real-world settings where there are limited resources to support peer navigators. Scalable, mHealth intervention approaches are needed to strengthen the impact of peers on the HIV care continuum outcomes among HBPLH. Mobile (m)Health and other technologies offer scalable platforms for intervention delivery through channels (e.g., online, mobile apps, SMS, and social networking platforms) that can overcome limitations and costs of in-person interventions. Combining both peer navigators and mHealth into a unified, scalable intervention could both strengthen the impact of peer navigators on HIV care continuum outcomes among HBPLH, and simultaneously reduce the resources needed to support peer navigators in clinical settings, effectively striking the ideal balance between maximizing clinical effect sizes and lowering peer navigator costs to promote sustainability. Partnering with a community-based clinic (San Ysidro Health, SYH) serving HBPLH under the Ryan White model in South San Diego, we propose a two-arm RCT (n=375) of an mHealth peer navigator intervention called Peers plus mobile App for Treatment in HIV (PATH). We will integrate two theoretically-grounded interventions developed by this team – one with a strong peer navigator component (called “Conexiones Saludables”) and the other with a scalable mHealth component (called “LinkPositively”)– into the PATH intervention, with the goal of amplifying the impact of peer navigators on viral suppression among HBPLH. We will integrate, refine, and usability test (Phase 1) these interventions into a unified, community-informed intervention, PATH, to be rigorously evaluated in a RCT (Phase 2). We will test the efficacy of PATH with 375 HBPLH (among whom >33% will report stimulant and/or opioid use in the past 6 months) to: 1) Improve sustained viral suppression (i.e., suppressed viral load at both 6- and 12-month follow-up) compared to usual care; 2) Examine the theory-informed mediators (e.g., self- efficacy to engage in HIV care, HIV stigma) through which PATH has the greatest impact on sustained viral suppression among HBPLH; and 3) Explore whether PATH significantly affects substance-related outcomes (e.g., frequency of substance use, engagement in substance abuse treatment) when compared to usual care among those using substances (i.e., stimulants and/or opioids).