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

描述（由申请人提供）：艾滋病毒是一种慢性疾病，需要坚持不懈地坚持药物治疗。因此，支持治疗依从性的干预措施可能也需要无止境。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去了效果。因此，我们提出了iHAART（“i$”），智能手机应用程序（“应用程序”），提供个性化的干预与内容和“剂量”，适应在真实的时间变量HAART坚持兴奋剂用户。i$最具创新性的特点是它的坚持干预。第一种类型的干预涉及来自真实的时间依从性数据的动态图形图像，使参与者能够监测他们自己的抗逆转录病毒依从性的健康影响。第二种类型的干预是组合文本消息。我们将与接受HAART的兴奋剂使用者进行形成性定性访谈，以确定他/她个人认为能有效促进他/她自己依从性的基于文本的信息。我们将在动机增强疗法（MET）中框定每个人的自我生成的文本消息，并根据效力组织它们，参与者希望收到的消息内容，以提高当前的依从性。然后我们将把消息分解为“对话状态”（例如，问候、干预、关闭等）。i$ software然后将从每个对话状态中随机选择一个项目，并将它们联合收割机组合成促进HAART坚持的新文本消息。这种方法允许自动创建数百万种不同的依从性干预措施。使用这两种类型的消息，i$将不断产生新的HAART依从性干预措施，以防止干预疲劳。然后，我们将在3个月内评估i$在兴奋剂中的功能和可接受性（例如，甲基苯丙胺，可卡因和MDMA）使用者接受HAART。坚持率下降将促使更频繁地提供效力更大的干预措施。提高遵守率导致主要支持性内容的交付频率降低。具体目标是：1）提供一种适应性的、个性化的、移动的技术，以提高HIV/AIDS患者的HAART依从性;和2）用自适应的、个性化的、移动的技术，以了解技术利用的障碍和促进因素，特别关注可用性以及可能构成干预措施潜在有效性和患者质量基础的作用机制-技术关系。创新：I$将根据粘附程度改变其干预的效力，以前从未实现过“剂量-反应”适应性。意义：i$独特地针对HAART依从性的长期维持，这是HIV治疗领域中特别严重的问题。影响：i$将提供持续的评估和个性化的反馈，以便为许多常见的，棘手的和昂贵的疾病提供强大的新干预措施。

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.