Mobile Health Intervention to Increase HIV Self Testing and Linkage to Services for High-Risk Men in China

项目摘要 该R 01应用程序的总体目标（PA-18-278：HIV检测、依从性和 保留以优化艾滋病毒护理连续性成果）是为了推进移动的卫生方法的科学 增加重复艾滋病毒自我检测（HST）的使用，并将其与艾滋病毒相关护理联系起来， 在艾滋病毒护理连续体的这些步骤上表现不佳。我们提出了一个名为“我们测试- WeLink”建立在中国MSM多年形成工作的基础上（R34 MH 106349）， 来自试点RCT的效果和干预可接受性、可行性和文化敏感性的强烈迹象。 干预使用“微信”移动的应用程序平台，该平台提供内置于应用程序中的多种功能， 促进健康信息传递和沟通渠道（例如，私人短信、群聊、 视频共享、GPS、即时消息、实时音频和视频通信）。以信息为导向， 动机-行为（IMB）模型和少数压力理论，我们将采用以用户为中心的设计过程 完善和扩展应用程序功能，以支持重复HST摄取、行为风险降低、污名应对 战略和自我效能与艾滋病毒护理联系起来。我们将使用一个可靠性-实现混合类型1 设计包括三个研究中心、两组RCT，以测试HST与HIV相关护理结果的联系，以及 定性研究，以检查实施和可扩展性。我们将招募1，800名艾滋病毒阴性的男男性行为者， 三个城市艾滋病在MSM中的高流行率--成都（9%）、苏州（13%）、武汉（11%）--分配 干预组（访问WeTest-WeLink应用程序）或对照组（关于HST的教育和被动 艾滋病毒检测呈阳性的个人转介艾滋病毒护理）。我们将在6个月、12个月和18个月时评估参与者 测量干预对主要结局的影响：重复使用HST（包括照片） 确认）和联系，以照顾个人谁测试艾滋病毒呈阳性。次要结果包括性风险 行为和使用艾滋病预防服务，我们将进行中介分析，以检查理论 行为改变的机制。我们将定性评估与干预相关的过程特征， 支持和/或阻碍实施和可扩展性， 实施研究（CFIR）。该项目将提供第一个已知的证据，移动的健康 作为针对男男性行为者的单一连续干预措施的一部分，采取一种优化艾滋病毒检测和与护理联系的方法。 这些发现对于优化未充分利用艾滋病毒服务的人群的护理级联至关重要， 在中国和世界其他地方，艾滋病毒检测和与护理服务的联系并不理想。

PROJECT SUMMARY The overarching goal of this R01 application (PA-18-278: Innovations in HIV Testing, Adherence, and Retention to Optimize HIV Care Continuum Outcomes) is to advance the science of mobile health approaches to increase uptake of repeat HIV self-testing (HST) and linkage to HIV-related care with populations that underperform on these steps of the HIV care continuum. We propose an intervention entitled “WeTest- WeLink” that builds on years of formative work with MSM in China (R34MH106349), demonstrating promising effects from a pilot RCT and strong indication of intervention acceptability, feasibility, and cultural sensitivity. The intervention uses the “WeChat” mobile app platform, which offers multiple features built into the app that facilitate health information delivery and communication channels (e.g., capacity for private texts, group chats, video sharing, GPS, instant messaging, real-time audio and visual communication). Guided by the Information- Motivation-Behavioral (IMB) model and Minority Stress Theory, we will employ a user-centered design process to refine and expand app features to support repeat HST uptake, behavioral risk reduction, stigma coping strategies, and self-efficacy to link to HIV care. We will use an Effectiveness-Implementation Hybrid Type 1 design consisting of a three site, 2-arm RCT to test HST and linkage to HIV related care outcomes as well as qualitative research to examine implementation and scalability. We will recruit 1,800 HIV negative MSM in three cities with HIV high-prevalence among MSM – Chengdu (9%), Suzhou (13%), Wuhan (11%) – allocated to the intervention (access to the WeTest-WeLink app) or control group (education about HST and passive referral to HIV care for individuals who test HIV positive). We will assess participants at 6-, 12-, and 18 months to measure intervention effects on primary outcomes: repeated use of HST (including photographic confirmation) and linkage to care for individuals who test HIV-positive. Secondary outcomes include sexual risk behaviors and use of HIV prevention services, and we will conduct mediation analysis to examine theoretical mechanisms of behavior change. We will qualitatively assess intervention-related process characteristics that enable and/or impede implementation and scalability informed by the Consolidated Framework for Implementation Research (CFIR). This project will provide the first known evidence for a mobile health approach to optimize both HIV testing and linkage to care as part of a single intervention continuum with MSM. Such findings can be crucial for optimizing the care cascade in populations that underutilize HIV services, such as MSM in China and elsewhere in the world where HIV testing and linkage to care services are sub-optimal.