An Accessible Digital Intervention to Promote HIV Testing/Counseling and Prevention Among Adolescents

摘要 艾滋病毒对少数群体青少年的影响尤为严重，他们中的大多数人既没有接受艾滋病毒检测， 和咨询（HTC）也不知道他们的状态。青春期是干预艾滋病毒的"机会之窗" 行为改变干预。实施和传播一些有效的艾滋病毒预防措施所面临的挑战 在青少年中的项目可能会限制其影响。为了应对这些挑战，创新的数字技术 可以作为干预措施来改善健康相关行为。他们满足青少年"他们在哪里，" 参与，为干预提供更一致的保真度，并且更容易传播，导致 以更低的成本获得更大的潜在覆盖范围。因此，本提案的目标是在已完成的工作的基础上 第一阶段项目进一步调整现有的基于iPad的艾滋病毒预防干预措施， 有效性，PlayForward：Elm City Stories（为11 - 14岁的青少年开发，重点关注性风险 减少），以创建一个新的干预措施，重点是促进青少年获得和吸收HTC， 14 - 16岁。在最初的PlayForward中，参与者创建一个虚拟角色，他们用这个角色来穿越生活， 面对挑战，做出会带来不同风险、收益和后果的决策。与会者 可以看到他们的行为如何影响他们的未来。干预涉及一系列现实的故事 代表初中或高中青少年面临的危险情况，参与者成功地 解决每一个故事，以获得"感官"和"权力"。"随后的第一阶段研究调整了干预措施 为了更加关注HTC，增强了故事情节，并进行了一项试点研究，证明了 增加实际的HTC、意图和知识。至于建议的第II期研究，我们会进行额外的 我们的产品开发人员和研究人员团队将扩大 在将干预措施转化为网络平台的同时，还应确定干预措施的内容和范围。我们将移动 通过与实施和营销伙伴合作，实现数字干预的商业化。 我们将在一项随机对照试验中对296名种族/少数民族进行适应性干预评估 青少年，确定其作为基于网络的干预措施的有效性，以影响他们寻求HTC的意图， 实际获得艾滋病毒/艾滋病检测，了解艾滋病毒/艾滋病和检测知识。他们将与干预互动， 每周2小时，持续6周，并将在基线、6周、3周和 6个月鉴于有令人信服的证据支持技术在促进健康方面的功效， 疾病预防，以及它们的可获得性，保真度和潜在的成本效益，这一建议 一个有效的、有吸引力的、量身定制的、高度可及的预防干预措施的承诺， 为了更大的可持续传播和对青少年这一弱势群体产生相当大的影响。

Abstract HIV disproportionately impacts minority adolescents, and most of them have neither undergone HIV testing and counseling (HTC) nor know their status. Adolescence is a "window of opportunity" to intervene with HIV behavior change interventions. Challenges to implementing and disseminating some effective HIV prevention programs in adolescents may limit their impact. To address these challenges, innovative digital technologies can be used as interventions to improve health-related behaviors. They meet adolescents "where they are at," are engaging, provide more consistent fidelity to the intervention, and are easier to disseminate, leading to potentially greater reach at a lower cost. Therefore, the goal of this proposal is to build on the work completed with a Phase I project to further adapt an existing iPad-based HIV prevention intervention with demonstrated efficacy, PlayForward: Elm City Stories (developed for adolescents aged 11-14 and focused on sexual risk reduction) to create a new intervention focused on promoting access to and uptake of HTC in adolescents, aged 14-16. In the original PlayForward, participants create a virtual character they use to travel through life, facing challenges and making decisions that bring different risks, benefits, and consequences. The participants can see how their actions influence their future. The intervention involves a series of realistic stories representing risky situations faced by adolescents in middle or high school, and participants successfully resolve each story to acquire "senses" and "powers." The subsequent Phase I study adapted the intervention for a greater focus on HTC with enhanced storylines and conducted a pilot study that demonstrated efficacy in increasing actual HTC, intentions, and knowledge. For the proposed Phase II study, we will conduct additional formative work with focus groups, and our team of product developers and researchers will expand on the content and scope of the intervention while translating the intervention to a web-based platform. We will move towards commercialization of the digital intervention by working with implementation and marketing partners. We will evaluate the adapted intervention in a randomized controlled trial with 296 racial/ethnic minority adolescents, determining its efficacy as a web-based intervention for impacting their intention to seek HTC, actual obtaining of HTC, and knowledge about HIV/AIDS and testing. They will interact with the intervention for 2 hours per week for 6 weeks, and standardized assessment data will be collected at baseline, 6 weeks, 3 and 6 months. Given the compelling evidence supporting the efficacy of technology in health promotion and disease prevention, and their increased access, fidelity, and potential cost-effectiveness, this proposal holds the promise of an effective, engaging, tailored, and highly accessible prevention intervention with the potential for greater sustainable dissemination and considerable impact on this vulnerable population of adolescents.