Adaptation and implementation of a behavioral mHealth intervention to reduce anxiety and depression and end the HIV epidemic in the rural South

适应和实施行为移动健康干预措施，以减少焦虑和抑郁并结束南方农村地区的艾滋病毒流行

• 批准号: 10619925
• 负责人: Preeti Manavalan
• 金额: $ 18.28万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-09 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619925
• 关键词: Address; Adopted; Adoption; Affect; Africa South of the Sahara; Anxiety; Award; Behavior Therapy; Behavioral; Caring; Communicable Diseases; Communities; Community Health Aides; Complex; Consolidated Framework for Implementation Research; Consultations; Counseling; Data; Effectiveness; Epidemic; Evaluation; Evidence based intervention; Failure; Florida; Friendships; Goals; HIV; HIV disparities; Health; Health Personnel; Health Services Accessibility; Health Technology; Health system; Hybrids; Individual; Intervention; Investments; Maintenance; Medical; Medicine; Mental Depression; Mental Health; Mental Health Services; Mentored Patient-Oriented Research Career Development Award; Mentorship; Modality; Modeling; Outcome; Persons; Physicians; Population; Program Development; Provider; Qualitative Research; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Proposals; Rural; Rural Population; Science; Scientist; Societal Factors; Specialist; System; Target Populations; Technology; Training; Transportation; Treatment outcome; Underserved Population; Universities; Viral; antiretroviral therapy; anxiety reduction; anxiety symptoms; clinical care; depressive symptoms; design; effective intervention; effectiveness evaluation; effectiveness outcome; effectiveness/implementation study; effectiveness/implementation trial; evidence base; experience; implementation evaluation; implementation intervention; implementation outcomes; implementation science; improved; intervention delivery; mHealth; member; novel; pilot test; problem solving therapy; professor; programs; randomized trial; rural area; rural counties; skills; social; stakeholder perspectives; therapy adherence; trial design; underserved community

ABSTRACT Untreated anxiety and depression are exceedingly common in people living with HIV (PLWH) in the rural South, a population critically affected by the HIV epidemic. Addressing mental health is essential to improving the disparate HIV burden in this population. Yet outside of routine clinical care, few interventions target mental health in PLWH in the rural South. Mobile health technology (mHealth) and community health worker (CHW)- delivered care are two intervention models that address barriers unique to rural, underserved, populations. Dr. Manavalan is an assistant professor in the Division of Infectious Diseases and Global Medicine at the University of Florida. She seeks a K23 award to gain skills, experience and preliminary data needed to become an independent physician-scientist focused on developing and implementing novel and scalable interventions in underserved communities that will contribute to Ending the HIV Epidemic. Through the training and research proposal outlined in this award, Dr. Manavalan will bridge the fields of HIV and mental health by incorporating evidence-based interventions effective in other settings into existing medical systems in Florida. In this 4-year study Dr. Manavalan will adapt an evidence-based CHW-delivered counseling intervention for delivery through an existing mHealth application, as a strategy to reduce anxiety and depression and maximize viral suppression in PLWH in the rural South. In Aim 1, she will conduct robust qualitative research with diverse key stakeholders, guided by the Consolidated Framework for Implementation Research (CFIR), to discern perspectives to inform adaption and implementation of the intervention. Next, in Aim 2, she will assemble a Design Consultation Team composed of 12 members from key stakeholder groups (PLWH from the target population, HIV and mental health providers, and mHealth and behavioral scientists) to assist in adapting CHW- delivered counseling for mHealth delivery, tailored to a rural population. Adaption of the intervention will occur iteratively, be informed from data from Aim 1 and will be guided by the ADAPT-ITT framework. Lastly, in Aim 3, she will pilot the adapted intervention with a type 1 hybrid effectiveness-implementation trial and assess implementation outcomes (reach, adoptability, implementation, maintenance) and preliminary effectiveness outcomes (viral suppression, HIV care retention, ART adherence, and anxiety and depression symptoms) using the RE-AIM model. The proposed program will enable Dr. Manavalan to gain expertise in 1) adaption and evaluation of behavioral interventions, 2) mHealth science, and 3) implementation science and hybrid trial design through mentorship with leading experts, didactic coursework, professional development programs, and application of research. This study will lay the groundwork for a fully powered R01 trial to evaluate implementation and effectiveness of the adapted intervention in underserved communities throughout the state of Florida.

摘要 未经治疗的焦虑和抑郁症在农村艾滋病毒感染者（PLWH）中非常普遍。 南部是受艾滋病毒流行病严重影响的人口。解决心理健康问题对于改善 艾滋病在这一人群中的不同负担。然而，在常规临床护理之外，很少有干预措施针对精神疾病。 南方农村地区艾滋病毒携带者的健康状况。移动的医疗技术（mHealth）和社区卫生工作者（CHW）- 提供护理是两种干预模式，旨在解决农村、服务不足的人口所特有的障碍。 Manavalan博士是纽约大学传染病和全球医学系的助理教授。 佛罗里达大学。她寻求K23奖，以获得成为K23所需的技能、经验和初步数据。 一个独立的医生，科学家专注于开发和实施新的和可扩展的干预措施， 这将有助于结束艾滋病毒的流行。通过培训和研究 在这个奖项概述的建议，马纳瓦兰博士将弥合艾滋病毒和心理健康领域的结合 在佛罗里达现有的医疗系统中，以证据为基础的干预措施在其他环境中有效。 在这项为期4年的研究中，Manavalan博士将采用循证的CHW提供的咨询干预， 通过现有的移动健康应用程序提供，作为减少焦虑和抑郁的策略， 南方农村地区艾滋病毒携带者中的病毒抑制。在目标1中，她将进行强有力的定性研究， 主要利益相关者在实施研究综合框架（CFIR）的指导下，辨别 为适应和实施干预措施提供信息。接下来，在目标2中，她将组装一个 设计咨询团队由12名来自主要利益相关者群体（目标群体中的PLWH）的成员组成 人口，艾滋病毒和心理健康提供者，以及移动健康和行为科学家），以协助适应CHW- 为移动医疗服务提供咨询，为农村人口量身定制。干预措施将发生调整 迭代地，从目标1的数据中获得信息，并将由ADAPT-ITT框架指导。最后，在目标3中， 她将通过1型混合有效性-实施试验来试点适应性干预，并评估 实施成果（覆盖面、可采用性、实施、维护）和初步成效 结果（病毒抑制，HIV护理保留，ART依从性以及焦虑和抑郁症状）， RE-AIM模型 拟议的计划将使Manavalan博士获得以下方面的专业知识：1）适应和评估 行为干预，2）移动健康科学，3）实施科学和混合试验设计， 与领先的专家指导，教学课程，专业发展计划，以及应用 research.这项研究将为一项全面的R 01试验奠定基础，以评估实施情况， 在整个佛罗里达州服务不足的社区进行适应性干预的有效性。