Research towards implementing technology-based prevention with positives

 描述（由申请人提供）：尽管抗逆转录病毒（ARV）药物和行为干预的可及性增加，但艾滋病毒仍然是全球范围内的公共卫生问题。获得干预措施的机会往往有限，特别是生活在农村和服务不足地区的艾滋病毒感染者。提供基于互联网或移动的短信的干预措施可以扩大覆盖面，越来越多的证据表明具有成本效益。然而，关于艾滋病毒携带者获得技术的机会和这种干预措施的可接受性的数据很少。同样重要的是，要了解向艾滋病毒携带者提供服务的卫生保健提供者的观点，以确保以技术为基础的预防或电子保健，以及[艾滋病毒]阳性干预措施（以下简称ePWPI）能够与现有的系统相适应，以接触艾滋病毒携带者。目标1是确定佛罗里达的PLH在多大程度上具有技术能力（即，设备访问）通过自己的设备参与基于技术的预防（或电子健康）与（艾滋病毒）阳性干预措施（以下简称ePWPI）。这将通过Ryan白色案例经理对佛罗里达的英语和西班牙语PLH进行全州范围的调查（约N=17656），以及对全州范围调查参与者的子集进行更深入的评估来完成。目的2是描述PLH通过自己的设备采用ePWPI的意愿，以及采用如何根据参与者而变化（例如，人口统计学，技术准备），技术（例如，文本、应用程序、视频聊天），以及干预特征（即，有用性、成本、相对 优势）。我们将通过一项探索性的顺序混合方法随访研究来实现这一目标，该研究的参与者来自全州范围的评估。从30定性，在人PLH访谈（第2a阶段）的结果，关于采用ePWPI的意愿将通知一个深入的主要是定量评估（N=400 PLH）的访问，使用和意愿，采用ePWPI，部分由一个适应技术准备和接受模型（TRAM35）的指导。目标3是审查关键利益攸关方（即，医疗保健提供者和阿索工作人员）对ePWPI与其现有系统之间的匹配度的看法，以接触客户和提供计划，并确定潜在的ePWPI实施策略，以最大限度地提高匹配度。这将通过半结构化面试来完成。这项研究是创新的，因为它是由执行研究的综合框架（CFIR）和TRAM的指导。研究结果将对制定有关ePWPI的科学议程至关重要，并将导致随后的R01应用，包括R01试验，该试验将测试将ePWPI与地理区域和亚群相匹配的方法的有效性，采用从R21中产生的实施策略。

 DESCRIPTION (provided by applicant): Despite increased access to antiretroviral (ARV) drugs and behavioral interventions, HIV remains a public health problem worldwide. Access to interventions is oftentimes limited, especially for people living with HIV (PLH) living in the rura and underserved areas. Providing Internet or mobile text-message based interventions can increase reach and there is increasing evidence of cost-effectiveness. However, data are scarce on PLH's access to technology and the acceptability of such interventions. It is also important to get the perspective of the health care providers who provide services to PLH to ensure that technology-based, or ehealth, prevention with [HIV] positives interventions (henceforth, ePWPIs) can fit with existing systems for reaching PLH clients. Aim 1 is to determine the extent to which PLH in Florida have the technical capacity (i.e., device access) to participate in technology-based, or eHealth, prevention with (HIV) positives interventions (henceforth, ePWPIs) via their own devices. This will be done with a statewide survey (approximate N=17656) of English and Spanish-speaking PLH in Florida via Ryan White case managers, as well as a more in-depth assessment with a subset of the statewide survey participants. Aim 2 is to describe PLH's willingness to adopt ePWPIs via their own devices and how adoption may vary based on participant (e.g., demographics, technology readiness), technology (e.g., text, app, video-chat), and intervention characteristics (i.e., perceptions of usefulness, cost, relative advantage). We will do this through an exploratory sequential mixed methods follow-up study with a sub-set of participants from the statewide assessment. Findings from 30 qualitative, in-person PLH interviews (Phase 2a) about willingness to adopt ePWPIs will inform an in-depth primarily quantitative assessment (N=400 PLH) regarding access, use, and willingness to adopt ePWPIs, guided in part by an adapted Technology Readiness and Acceptance Model (TRAM35). Aim 3 is to examine key stakeholder (i.e., medical care providers and ASO staff) perceptions of fit between ePWPIs and their existing systems for reaching clients and delivering programs, and identify potential ePWPI implementation strategies to maximize fit. This will be done via semi-structured interviews. The study is innovative as it is guided by the consolidated framework for implementation research (CFIR) and the TRAM. Findings will be critical in shaping the scientific agenda regarding ePWPIs and will lead to subsequent R01 applications, including a R01 trial that tests effectiveness of an approach that matches ePWPIs to geographical areas and subpopulations, employing implementation strategies that emerged from this R21.