Improving engagement in care via Community-based mHealth Motivational Interviewing Tool for HIV-positive youth (COMMIT+)

项目摘要 在世界范围内，青年艾滋病毒携带者(青年会)缺乏护理，健康状况较差 结果比成年人做的要好。尽管如此，仍然缺乏有效的干预措施来改善青瓦台的 参与护理：遵守门诊预约，坚持抗逆转录病毒治疗。干预措施 要解决这个问题，主要集中在外部动机、激励和环境重新设计上。 然而，来自社会心理学的令人信服的证据表明，内部而不是外部， 激励因素与保持积极健康的行为密切相关。 激励面谈(MI)在世界各地都被用来加强客户的内部 提高对包括艾滋病毒在内的多种疾病的护理参与度的动机。同时，社区 卫生工作者(CHW)已经证明有能力接触到脆弱的农村人口，他们 不太可能从事护理工作。然而，一个共同的发现是，没有持续的MI训练 监督会导致技能衰退，而CHW又会回到评判建议的方式，这可能会疏远他们 YLWH。 在过去十年我们在尼泊尔和印度农村地区工作的基础上，我们建议解决这些问题 开发基于社区的艾滋病毒mHealth动机访谈工具所面临的挑战- 积极的青年(承诺+)。CHWS将使用Commit+来：1)获得决策支持以交付 MI用于社区中的个别案例，以及2)捕获客户同意的录音 由其主管审查和反馈的互动，以便CHW可以保持MI技能 最初的训练期。 在提议的研究中，我们将为未来的多站点试验开发、研究和改进Commit+，以 提高对妇幼保健院的关怀参与度。我们会追求两个目标：1)发展社区- 基于mHealth的艾滋病毒阳性青年激励性访谈工具(Commit+)，以支持 社区卫生工作者使用和维持激励性访谈技能；以及2)评估 YLWH、CHW及其主管承诺+改善的接受度和可行性 坚持抗逆转录病毒治疗、门诊预约和CD4计数。以人为本 设计思想，我们将迭代开发Commit+并在具有最高级别之一的站点上进行测试 尼泊尔艾滋病毒的发病率和流行率，以及社区卫生工作者已经使用移动设备协助 临床任务。 在完成时，我们预计已经采用了Commit+并展示了它的可接受性和 在妇幼保健院、卫生福利院和他们的主管中进行可行性研究，并准备了申请 在尼泊尔和印度进行了多点试验，MPI在那里已经工作了十多年。

Project Summary Worldwide, youth living with HIV (YLWH) are poorly engaged in care and have worse health outcomes than adults do. Despite this, there is a lack of effective interventions to improve YLWH's engagement in care: keeping clinic appointment and adhering to antiretroviral therapy. Interventions to address this have largely focused on external motivations, incentives, and environment redesign. However, there is compelling evidence from social psychology that internal, rather than external, motivators are strongly associated with maintenance of positive and healthy behaviors. Motivational Interviewing (MI) has been used around the world to enhance the client's internal motivation to improve care engagement for numerous diseases, including HIV. In parallel, Community Health Workers (CHWs) have demonstrated the capacity to reach vulnerable, rural populations, who are less likely to engage in care. However, a common finding is that MI training without ongoing supervision leads to skill decay, and CHWs return to judgmental advice-giving, which can alienate YLWH. Building on our work over the last ten years in rural Nepal and India, we propose to address these challenges by developing a Community-based mHealth Motivational Interviewing Tool for HIV- positive youth (COMMIT+). COMMIT+ will be used by CHWs to: 1) obtain decision-support to deliver MI for individual cases in the community, and 2) capture consented audio recordings of client interactions for review and feedback by their supervisors so CHWs can maintain MI skills beyond the initial training period. In the proposed study, we will develop, study, and refine COMMIT+ for a future multi-site trial to improve care engagement about YLWH. We will pursue two aims: 1) To develop the Community- based mHealth Motivational Interviewing Tool for HIV-positive youth (COMMIT+) to support community health workers in using and sustaining motivational interviewing skills; and 2) To assess the acceptability and feasibility of COMMIT+ among YLWH, CHWs, and their supervisors to improve adherence to antiretroviral therapy, clinic appointments, and CD4 counts. Using human-centered design thinking, we will iteratively develop COMMIT+ and test it at a site with one of the highest incidence and prevalence of HIV in Nepal, and where CHWs already use mobile devices to assist in clinical tasks. At completion, we expect to have adapted COMMIT+ and demonstrated its acceptability and feasibility among YLWH, CHWs, and their supervisors, and to have prepared an application for a multi-site trial in Nepal and India, where the MPIs have worked for over a decade.