Research towards implementing technology-based prevention with positives

 描述(由申请人提供)：尽管获得抗逆转录病毒(ARV)药物和行为干预的机会增加，但艾滋病毒仍然是一个全球公共卫生问题。获得干预的机会往往有限，尤其是对于居住在农村和服务不足地区的艾滋病毒携带者。提供基于互联网或移动短信的干预措施可以扩大覆盖范围，而且越来越多的证据表明具有成本效益。然而，关于公共卫生部门获得技术和这种干预措施的可接受性的数据很少。同样重要的是，了解为PLH提供服务的卫生保健提供者的观点，以确保基于技术或电子健康的[HIV]阳性干预措施(以下简称ePWPI)能够适合于接触PLH客户的现有系统。目标1是确定佛罗里达州的公共卫生部门在多大程度上拥有通过自己的设备参与以技术为基础的、或电子健康的(HIV)阳性干预措施(以下简称ePWPI)的技术能力(即设备访问)。这将通过瑞安·怀特的案例经理对佛罗里达州讲英语和西班牙语的公共卫生部门进行全州范围的调查(约N=17656)，以及对全州范围内调查参与者的子集进行更深入的评估。目标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(例如，人口统计数据、技术准备情况)、技术(例如，文本、应用程序、视频聊天)和干预特征(即，对有用性、成本、相对的感知)而变化 优势)。我们将通过对全州评估参与者的子集进行探索性顺序混合方法后续研究来实现这一点。关于采用ePWPI的意愿的30个定性的、面对面的公共卫生部门访谈(阶段2a)的结果将为关于采用ePWPI的访问、使用和意愿的深入的、主要是定量的评估(N=400 PLH)提供信息，部分地以适应的技术准备和接受模型(TRAM35)为指导。目标3是检查主要利益相关者(即医疗保健提供者和ASO工作人员)对ePWPI与其用于接触客户和交付计划的现有系统之间的匹配度的看法，并确定潜在的ePWPI实施战略以最大限度地匹配。这将通过半结构化面试来完成。这项研究具有创新性，因为它是以执行研究综合框架和有轨电车为指导的。研究结果将对形成关于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，该试验采用从该R21产生的实施战略，测试将ePWPI与地理区域和亚群相匹配的方法的有效性。

 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.