A Mobile, Personalized Intervention with Real-Time Adaptation to HAART Adherence

描述(申请人提供)：HIV是一种慢性疾病，需要坚持不懈地坚持药物治疗。因此，支持治疗坚持的干预措施可能也需要永无止境。不幸的是，大多数改善HAART依从性的干预措施在试验结束后几周内就失效了。因此，我们建议iHAART(“i$”)，这是一款智能手机应用程序(“app”)，它提供个性化干预，提供内容和“剂量”，实时适应兴奋剂用户不同的HAART依从性。I$最具创新性的特点是其遵守干预措施。第一类干预包括来自实时依从性数据的动态图形图像，允许参与者监测他们自己的抗逆转录病毒依从性对健康的影响。第二种干预类型是组合短信。我们将对接受HAART的兴奋剂使用者进行形成性定性访谈，以确定S/他个人认为在促进她/他自己遵守方面将有效的文本信息。我们将在激励增强疗法(MET)中框定每个人的自我生成的文本消息，并根据参与者希望收到的消息的效力和内容来组织它们，以提高当前的遵守程度。然后，我们将信息分解为“对话状态”(例如，问候、干预、结束等)。然后，I$SOFTWARE将从每个对话状态中随机选择一项，并将它们组合成新的文本消息，以促进遵守HAART。该方法允许自动创建数百万种不同的遵守干预措施。使用这两种类型的信息，i$将不断产生新的HAART遵守干预措施，以防止干预疲劳。然后，我们将在3个月的时间内评估接受HAART的兴奋剂(如甲基苯丙胺、可卡因和MDMA)使用者I$的功能性和可接受性。遵守的减少将引发更频繁、更有效的干预措施的提供。提高遵从性会降低主要是支持性内容的交付频率。具体目标是：1)提供适应性、个性化的移动技术，以提高艾滋病毒/艾滋病患者对HAART的依从性；以及2)评估参与者使用适应性、个性化、移动技术的体验，以了解技术应用的障碍和促进者，特别关注可用性以及可能支撑干预措施的潜在有效性和患者-技术关系质量的行动机制。创新：根据坚持程度的不同，其干预的效力将有所不同，以前从未实现过“剂量-反应”适应性。意义：I$的唯一目标是长期维持HAART的遵守，这在艾滋病毒治疗领域是一个特别严重的问题。影响：I$将提供持续的评估和个性化的反馈，以实现对许多常见、顽固和昂贵的疾病的强有力的新干预。 与公共卫生相关：艾滋病毒是一种慢性疾病，需要经常服从药物治疗；不幸的是，大多数旨在提高HAART依从性的干预措施在试验结束后几个月内失效。IE通过提供实时变化的移动干预，独特地针对长期维持HAART的遵守，这在艾滋病毒兴奋剂使用者中是一个特别的问题。IE将提供持续的评估和个性化的反馈，以实现对许多常见、具有挑战性和昂贵的疾病的强大的新干预。

DESCRIPTION (provided by applicant): HIV is a chronic disease that demands unremitting adherence to medication. Interventions that support therapeutic adherence may therefore need to be unending as well. Unfortunately, most interventions to improve HAART adherence lose effectiveness within weeks of trial conclusion. We therefore propose iHAART ("i$"), a smartphone application ("app") that delivers personalized interventions with content and "dose" that adapts in real time to variable HAART adherence in stimulant users. The most innovative features of i$ are its adherence interventions. The first type of intervention involves dynamic graphical images derived from real time adherence data that allow participants to monitor the health effects of their own antiretroviral adherence. The second genre of intervention is combinatorial text messages. We will conduct formative qualitative interviews with stimulant users receiving HAART to identify text-based messages s/he personally believes would be effective at promoting adherence for her/himself. We will frame each individual's self-generated text messages in Motivational Enhancement Therapy (MET) and organize them according to potency, the content of message the participant would like to receive to improve upon a current degree of adherence. Then we will dissect messages into "dialogue states" (eg, greeting, intervention, closing, etc). i$ software will then randomly select one item from each dialogue state and combine them into new text messages that promote HAART adherence. This method allows the automated creation of millions of different adherence interventions. Using these two types of messages, i$ will continually produce fresh HAART adherence interventions to prevent intervention fatigue. We will then assess over a 3 month period the functionality and acceptability of i$ among stimulant (e.g., methamphetamine, cocaine, and MDMA) users receiving HAART. Declining adherence will trigger the more frequent delivery of interventions with greater potency. Improving adherence leads to the less frequent delivery of content that is primarily supportive. The specific aims are: 1) To provide an adaptive, personalized, mobile technology to improve HAART adherence in patients with HIV/AIDS; and 2) To evaluate participant experience with an adaptive, personalized, mobile technology to understand the barriers and facilitators of technology utilization with a specific focus on usability as well as mechanisms of action that might underlie the potential effectiveness of the interventions and quality of the patient-technology relationship. Innovation: i$ will vary the potency of its intervention according to the degree of adherence, a "dose-response" adaptability has never before been achieved. Significance: i$ uniquely targets long-term maintenance of HAART adherence, a particularly acute problem in the HIV treatment field. Impact: i$ will provide ongoing assessment and individualized feedback to enable powerful new interventions for many common, intractable, and expensive diseases. PUBLIC HEALTH RELEVANCE: HIV is a chronic disease that demands constant obedience to medication; unfortunately most interventions to improve HAART adherence lose effectiveness within months of trial conclusion. ie uniquely targets long-term maintenance of HAART adherence, a particularly problem in HIV stimulant users by offering mobile interventions that change, in real time. ie will provide ongoing assessment and individualized feedback to enable powerful new interventions for many common, challenging, and expensive diseases.