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

项目总结 本R01申请的首要目标(PA-18-278：艾滋病毒检测、遵守和 留存以优化艾滋病毒护理连续结果)是推动移动卫生方法的科学 增加对艾滋病毒重复自我检测(HST)的接受，并与符合以下条件的人群的艾滋病毒相关护理挂钩 在艾滋病毒护理连续体的这些步骤上表现不佳。我们提出了一项名为“我们测试-- 在中国(R34MH106349)与MSM的多年形成工作的基础上建立的WeLink，展示了有前途的 试验性随机对照试验的效果以及干预措施的可接受性、可行性和文化敏感性的强烈指示。 此次干预使用的是“微信”移动应用程序平台，该平台提供多种内置到应用程序中的功能 促进健康信息传递和通信渠道(例如，私人文本、群聊、 视频共享、GPS、即时消息、实时音频和视频通信)。在信息的指引下- 动机-行为(IMB)模型和少数群体压力理论，我们将采用以用户为中心的设计过程 改进和扩展应用程序功能，以支持重复使用HST、降低行为风险、应对污名 战略，以及与艾滋病毒护理相联系的自我效能。我们将使用效率-实施混合型1 设计包括三个部位、两个臂的随机对照试验，以测试HST和与艾滋病毒相关护理结果的联系以及 进行定性研究，以检查实施情况和可扩展性。我们将在中国招募1800名HIV阴性男男性接触者 男男性接触者中艾滋病毒高流行的三个城市-成都(9%)、苏州(13%)、武汉(11%)-分配 对干预组(访问WeTest-WeLink应用程序)或对照组(关于HST和被动的教育 转介给艾滋病毒检测呈阳性的个人的艾滋病毒护理)。我们将在6个月、12个月和18个月时对参与者进行评估 评估干预对主要结果的影响：重复使用HST(包括照相 确认)和与护理艾滋病毒检测呈阳性的个人的联系。次要结果包括性风险 艾滋病预防服务的行为和使用情况，我们将进行中介分析，以检验理论 行为改变的机制。我们将定性评估与干预相关的流程特征， 支持和/或阻碍综合框架提供的实施和可扩展性 实施研究(CFIR)。该项目将提供第一个已知的移动医疗证据 作为男男性接触者单一干预连续体的一部分，优化艾滋病毒检测和与护理的联系的方法。 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，例如 在中国和世界其他地方的男男性接触者中，艾滋病毒检测和与护理服务的联系是次优的。

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.