Mhealth for Pre-exposure Prophylaxis Adherence by Young Adult MSM

摘要：环境与健康小组、塔夫茨传染病诊所和棕榈树艾滋病生活 支持服务，将在Patricia Weitzman博士的领导下合作开发和测试 有史以来第一个针对个人、发展和文化敏感的移动医疗的有效性 (MHealth)PrEP依从性干预称为DOT。这项干预将针对不同文化的年轻人 18-35岁的男性，与男性发生性关系(基督教青年会)。每天服用PrEP药丸，可以通过以下方式降低艾滋病毒风险 92-99%。CDC估计，在美国的Impact模型中，每天服用PrEP药丸适合50万名MSM。 显示，即使是适度增加预防接种计划的依从性，也可以将MSM中新的艾滋病毒感染人数减少29% 20年了。最近年轻人中艾滋病毒感染率的上升，特别是少数民族基督教男同性恋者，表明了这种价值 对YMSM的PrEP摄取和依从性支持。在PrEP疗效试验中，年轻是最一致的 与PrEP依从性低有关。手机在年轻人中的广泛普及使mHealth 为不同文化背景的基督教青年会提供PrEP遵守支持的一种理想、低成本的方法。我们的DOT mHealth 干预反映了对年轻人决策的发展理解，并具有独特的组合 运用社会认知理论、积极心理学和行为经济学的原理，都朝着目标前进 支持PrEP的遵守。拟议的项目是基于Weitzman博士成功的第一阶段试验 DOT，这导致PrEP依从性、PrEP治疗自我效能和意向显著改善 在使用DOT六周的YMSM中遵循PrEP治疗指南。我们建议的第2阶段DOT 移动健康干预通过添加推荐的新功能和 增强，包括：1)针对压力负担的新文本2)社会支持的新在线社区3) 与联邦危机文本行的新联系4)通过虚拟化身实现新的游戏化5)新的自动时区 调整6)新的基于云的平台以查看用户参与度7)诊所预约的新日历 和药房配药8)增强了避孕药提醒的个性化，9)增强了依从性图表 旨在与医疗保健提供者共享。在第二阶段，我们将测试DOT在改善 随机对照试验中的准备依从性。我们的目标是帮助阻止YMSM中艾滋病毒的上升。 DOT的另一个潜在好处是改进了关于mHealth可能如何处理患者的证据基础 支持艾滋病毒预防和其他医疗保健方面的问题，以实现减少健康的更大目标 差距。

Abstract: Environment and Health Group, Tufts Infectious Disease Clinic, and Palmetto AIDS Life Support Services, will collaborate under the leadership of Patricia Weitzman, PhD, to develop and test the effectiveness of the first-ever individually-tailored, developmentally- and culturally-sensitive, mobile health (mhealth) PrEP adherence intervention called DOT. The intervention will target culturally-diverse, young adult men, ages 18-35, who have sex with men (YMSM). When the PrEP pill is taken daily, it can reduce HIV risk by 92-99%. The CDC estimates the daily PrEP pill is appropriate for 500,000 MSM in the U.S. Impact models show even modest increases in PrEP adherence could reduce new HIV infections among MSM by 29% over 20 years. The recent rise in HIV infection among young people, particularly minority YMSM, points to the value of PrEP uptake and adherence support for YMSM. In PrEP efficacy trials, younger age was the most consistent correlate with low PrEP adherence. Extensive mobile phone penetration among young adults makes mhealth an ideal, low-cost method for providing PrEP adherence support to culturally-diverse YMSM. Our DOT mhealth intervention reflects a developmental understanding of young adult decision-making, and is uniquely combined with principles from social cognitive theory, positive psychology and behavioral economics, all toward the goal of supporting PrEP adherence. The proposed project is based on Dr. Weitzman's successful Phase 1 trial of DOT, which led to significant improvements in PrEP adherence, PrEP treatment self-efficacy, and intention to follow PrEP treatment guidelines among the YMSM that used DOT for six weeks. Our proposed Phase 2 DOT mhealth intervention is directly responsive to Phase 1 findings by adding recommended new features and enhancements, including: 1) new texts targeting stress burden 2) new online community for social support 3) new linkage to the federal crisis text line 4) new gamification via a virtual avatar 5) new automatic time-zone adjustments 6) new cloud-based platform to view user engagement 7) new calendar for clinic appointments and pharmacy refills 8) enhanced personalization of pill reminders and 9) enhanced adherence graphing designed for sharing with healthcare providers. In Phase 2, we will test the effectiveness of DOT at improving PrEP adherence in a randomized controlled trial. Our goal is to help stop the rise in HIV among YMSM. Another potential benefit of DOT is advancement of the evidence base on how mhealth might address patient support issues in HIV prevention and other healthcare concerns toward the larger goal of reducing health disparities.