AllyQuest: Engaging HIV+ YMSM in Care through Social Networking and Gamification

 描述(由申请人提供)：在美国，与男性发生性行为的年轻男性(YMSM)是艾滋病毒发病率唯一上升的群体。被诊断为艾滋病毒携带者的青少年和年轻人在试图将传统的青少年发展问题与生活负担结合在一起时，往往面临着广泛的困难 一种被高度贬低的疾病。这些困难，包括心理困扰、缺乏知识、缺乏社会支持和耻辱，为充分参与医疗保健造成了障碍。参与护理对于被诊断感染艾滋病毒的青年至关重要，以改善医疗结果(例如获得抗逆转录病毒药物、病毒抑制、生存)和公共卫生结果(例如通过性传播病毒)。尽管被诊断为艾滋病毒携带者的人迫切需要进行护理，但与成年人相比，艾滋病毒+青年显示出较低的病毒学抑制率和较高的随访率。高昂的实施成本以及对隐私和污名的担忧可能会限制面对面行为干预的可扩展性。此外，对新确诊的艾滋病毒携带者青年的干预措施通常是在护理环境中提供的，因此错过了那些推迟进入护理的青年，这是艾滋病毒护理级联中失去后续行动的一个关键点。因此，开发和测试创新的移动卫生应用程序对于增加干预吸收和优化艾滋病毒/YMSM护理的参与度至关重要。年轻人的高手机拥有率和高技术使用率提供了一个独特的平台，以提供量身定制的、有吸引力的艾滋病毒健康促进干预措施。这项拟议的研究将开发AllyQuest，这是一种针对HIV+YMSM的互动手机干预，利用社交网络、基于游戏的机制和基于故事的框架来指导行为改变。干预措施以社会认知理论、叙事传播和说服性技术原则为基础，旨在利用社会参与，并针对新诊断的青年中已查明的护理障碍，即艾滋病毒健康素养低、缺乏支持和内在化的耻辱。人物驱动叙事元素的使用既增加了娱乐吸引力，也增加了干预的整体相关性。使用迭代研究设计，我们将与目标人群成员和Ayogo合作，Ayogo是应用游戏心理学和健康行为改变的全球领先者，为新诊断的HIV+YMSM(16-24岁)开发和定制干预内容，以最大限度地提高相关性和可用性。AllyQuest将建立在EmPowerTM平台上，这是Ayogo的专有游戏化平台，利用社交网络和游戏心理来推动行为改变。这项R21应用的总体目标是开发和评估可行性和可接受性，这是一种潜在的高影响干预措施，可以改善新诊断的HIV+YMSM在连续护理过程中的多个阶段的保留率。该项目的成功完成将为未来进行更大规模的疗效试验提供所需的数据。

 DESCRIPTION (provided by applicant): In the United States, young men who have sex with men (YMSM) are the only group experiencing an increase in HIV incidence. Adolescents and young adults who are diagnosed with HIV are often confronted with a wide range of difficulties as they try to integrate traditional adolescent developmental issues with the burden of living with a highly stigmatized illness. These difficulties, including psychological distress, lack of knowledge, lack of social support, and stigma, create barriers for adequately engaging in medical care. Engagement in care is crucial for youth diagnosed with HIV in order to improve both medical outcomes (e.g. access to antiretroviral medication, viral suppression, survival) and public health outcomes (e.g. viral transmission via sex). Despite the critical need for those diagnosed with HIV to engage in care, HIV+ youth demonstrate lower rates of virologic suppression and higher rates of loss to follow-up compared to adults. High implementation costs and concerns around privacy and stigma may limit the scalability of face-to-face behavioral interventions. Further, interventions for newly diagnosed HIV+ youth are typically delivered within care settings thus missing those youth who delay entering care, a critical point of loss-to-follow up in the HIV care cascade. Thus, the development and testing of innovative, mobile health applications is critical for increasing intervention uptake and optimizing engagement in care for HIV+ YMSM. High rates of mobile phone ownership and technology use among youth provide a unique platform to deliver a tailored, engaging HIV health promotion intervention. The proposed study will develop AllyQuest, an interactive mobile phone intervention for HIV+ YMSM that utilizes social networking, game-based mechanics and a story-based framework to guide behavior change. Grounded in Social Cognitive Theory, narrative communication and the principles of persuasive technology, the intervention is designed to capitalize on social involvement and target the identified barriers to care among newly diagnosed youth, namely, low HIV health literacy, lack of support, and internalized stigma. The use of character-driven narrative elements serves to increase both the entertainment appeal and overall relevance of the intervention. Using an iterative research design we will work with members of the target population and Ayogo, a global leader in the application of game psychology and health behavior change, to develop and tailor the intervention content for maximal relevance and usability for newly diagnosed HIV+ YMSM (aged 16- 24). AllyQuest will be built on the EmpowerTM platform, Ayogo's proprietary gamification platform which uses social networking and game psychology to motivate behavior change. The overall goals of this R21 application are to develop and evaluate for feasibility and acceptability a potentially high-impact interventio that improves retention along multiple stages in the continuum of care for newly diagnosed HIV+ YMSM. The successful completion of this project will provide data needed to conduct a future larger efficacy trial.