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

摘要 未经治疗的焦虑和抑郁在农村艾滋病毒感染者 (PLWH) 中极为常见 南部地区人口受到艾滋病毒流行的严重影响。解决心理健康问题对于改善心理健康至关重要 该人群中不同的艾滋病毒负担。然而，除了常规临床护理之外，很少有针对心理的干预措施 南方农村地区艾滋病毒感染者和艾滋病患者的健康状况。移动医疗技术 (mHealth) 和社区卫生工作者 (CHW) - 提供护理是两种干预模式，旨在解决服务不足的农村人口特有的障碍。 马纳瓦兰博士是该大学传染病和全球医学部的助理教授 佛罗里达大学。她寻求 K23 奖项，以获得成为一名优秀人才所需的技能、经验和初步数据。 一位独立的医师科学家，专注于开发和实施新颖且可扩展的干预措施 服务不足的社区将为结束艾滋病毒流行做出贡献。通过培训和研究 该奖项概述的提案中，马纳瓦兰博士将通过纳入艾滋病毒和心理健康领域的桥梁 在佛罗里达州现有医疗系统的其他环境中有效的循证干预措施。 在这项为期 4 年的研究中，Manavalan 博士将采用由社区卫生工作者提供的基于证据的咨询干预措施，以 通过现有的移动医疗应用程序进行交付，作为减少焦虑和抑郁并最大化 南方农村地区艾滋病病毒感染者的病毒抑制。在目标 1 中，她将开展稳健的定性研究 主要利益相关者在实施研究综合框架（CFIR）的指导下，辨别 为干预措施的适应和实施提供信息的观点。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群体（来自目标群体的 PLWH）的成员组成 人口、艾滋病毒和心理健康提供者以及移动医疗和行为科学家）协助适应 CHW- 提供针对农村人口的移动医疗咨询。干预措施将会发生调整 迭代地从目标 1 的数据中获取信息，并以 ADAPT-ITT 框架为指导。最后，在目标 3 中， 她将通过 1 类混合有效性实施试验来试行调整后的干预措施，并评估 实施成果（覆盖范围、可采用性、实施、维护）和初步有效性 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 博士能够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，以及 3) 实施科学和混合试验设计 领先专家的指导、教学课程、专业发展计划以及应用 研究。这项研究将为全面支持的 R01 试验奠定基础，以评估实施情况和 佛罗里达州服务欠缺社区的适应性干预措施的有效性。

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.