Real-Time Assessment of Triggers and Coping Responses in China

描述（由申请人提供）：针对阿片类药物使用者中艾滋病毒/艾滋病的高发病率，中国最近实施了美沙酮维持治疗（MMT）计划，以降低注射吸毒者（IDUs）中的艾滋病毒风险。虽然中国在实施MMT方面取得了长足的进步，但MMT患者中阿片类药物持续使用率和辍学率仍然很高。改善自我监测和自我管理是慢性病管理的重要因素，但这些概念对中国MMT提供者和患者来说相对较新。根据认知行为理论，管理触发因素/风险和建立应对技能对预防复发和持续康复至关重要。更好地了解MMT患者的常见触发因素和有效的应对策略将为制定有效的干预措施提供基础。通信技术和手机在中国的普及为与患者接触和建立网络以及收集关于触发因素和应对反应的生态瞬时评估（EMA）数据提供了很好的机会。拟议的项目将测试使用手机和短信技术收集触发和应对反应的EMA数据的可行性和可接受性。加州大学洛杉矶分校的研究人员开发了一个名为“ANDWellness”的开源移动的健康平台，用于支持自我监测和行为干预。我们建议建立在这个创新的平台上，在中国的MMT患者中进行触发和应对反应的实时评估。该研究的目的是（1）开发一个交互式手机支持的移动的健康原型，建立个性化的风险或触发因素， 支持知识和技能建设，包括应对策略;（2）进行试点研究，以评估EMA数据的可靠性和有效性。次要目的是获得与结局数据相关的自我监测的初步证据（例如，MMT保留，禁欲）。该项目将分两个阶段完成：第一阶段将开发基于智能手机的ANDWellness应用程序原型。我们也会评估原型的可接受性和可行性。第二阶段将包括一个试点测试，以检查可接受性和遵守ANDWellness原型收集EMA数据的触发和反应，EMA与回顾性召回和尿液检测的对应关系，以及EMA和一些有限的结果之间的关系。这些试点工作将使我们为未来基于手机技术的干预发展做好准备。该研究的长期目标是制定有前途的策略，通过利用手机使用的普及来优化治疗效果并支持持续恢复，并适应和应用循证原则来解决药物使用和艾滋病毒/HCV风险行为。因此，本研究将有助于文献的触发和应对策略 并将扩大NIDA的使命，即颁布基于研究的干预措施，以改善治疗服务，减少全球HIV/HCV传播。

DESCRIPTION (provided by applicant): Responding to high rates of HIV/AIDS among opiate users, China has recently implemented methadone maintenance treatment (MMT) programs in order to reduce HIV risks among injection drug users (IDUs). While China has made strides in the implementation of MMT, high rates of continued opiate use and dropout among MMT patients remain problematic. Improved self-monitoring and self-management are important elements in chronic disease management, but these concepts are relatively new to Chinese MMT providers and patients. According to cognitive behavioral theories, managing triggers/risks and building coping skills are critical in relapse prevention and sustained recovery. A better understanding of common triggers and effective coping strategies among MMT patients will provide a foundation for developing effective interventions. Communication technologies and the proliferation of cellphones in China provide great opportunities to engage and network with patients and to collect ecological momentary assessment (EMA) data on triggers and coping responses. The proposed project will test the feasibility and acceptability of EMA data collection of triggers and coping responses using cellphone and text messaging technology. An open-source mobile health platform, called "ANDWellness," has been developed by UCLA researchers for supporting self-monitoring and behavioral interventions. We propose to build upon this innovative platform to conduct real-time assessment of triggers and coping responses among MMT patients in China. The study aims are (1) To develop an interactive cellphone-supported mobile health prototype that establishes individualized profiles of risks or triggers and that supports knowledge and skill building, including coping strategies; and (2) To conduct a pilot study to assess the reliability and validity of the EMA data. A secondary objective is to obtain preliminary evidence on self-monitoring in relation to outcome data (e.g., MMT retention, abstinence). The project will be accomplished in two phases: Phase I will develop a smartphone-based prototype of the ANDWellness application. We will also assess the acceptability and feasibility of the prototype. Phase II will consist of a pilot test to examine th acceptability of and compliance with the ANDWellness prototype collecting EMA data on triggers and responses, the correspondence of EMA with the retrospective recall and urine testing, and the relation between EMA and some limited outcomes. These pilot efforts will prepare us for future intervention development based on cellphone technology. The long-term goal of this line of research is to develop promising strategies that optimize treatment effectiveness and support sustained recovery by taking advantage of the popularity of cellphone use, and adapting and applying evidence-based principles to address drug use and HIV/HCV risk behaviors. Thus, the study will contribute to the literature on triggers and coping strategies and will extend NIDA's mission of promulgating research-based interventions to improve treatment services and reduce HIV/HCV transmission globally.