A mobile phone intervention using a relational human talking Avatar to promote multiple stages of the HIV Care Continuum in African American MSM

摘要：艾滋病毒阳性的非洲裔美国男性与男性发生性关系（AAMSM）的比例最低， 保持护理的百分比，并且不太可能有病毒抑制，这一结果依赖于 抗逆转录病毒治疗（ART）依从性。该提案侧重于创新理论驱动的干预 旨在帮助改善AAMSM针对艾滋病毒护理连续体3个阶段的成果，（1）保留， (2)坚持抗逆转录病毒药物治疗，和（3）病毒抑制。我的个人健康指南 创新的谈话关系人类化身移动的电话应用程序，以参与艾滋病毒阳性的AAMSM， 坚持和保持护理。这个应用程序的开发是由信息动机告知 行为技能模型，侧重于信息和动机之间的反馈，影响一个人的 行为技能、行为和期望的健康结果。在用户的家中或任何地方， 有了他们的手机，阿凡达可以鼓励健康的行为，承认耻辱和同情地说话， 用声音教导识字率低的人，采用可信的文化上适当的措辞，并邀请用户 听取其他艾滋病毒阳性者及其照顾者的建议和激励故事。一项关于艾滋病毒的试点研究- 年龄在18-34岁之间的积极AAMSM表现出可接受性，对应用程序的热情，以及初步的 功效作为UIC、埃默里大学和密西西比医科大学合作的一部分， 中心，我们建议测试我的个人健康指南头像应用程序对年轻艾滋病毒的有效性- 阳性AAMSM。在这项为期5年的研究中，应用程序将根据试点数据（目标1）进行完善，然后在250 年龄在18-34岁之间且基线时可检测到病毒载量的HIV阳性AAMSM将被随机分组 我的个人健康指南头像应用程序或食品安全头像应用程序控制干预， 6-月期间（目标2）。无线监测的ART依从性将在基线时收集1个月， 无线监测的抗逆转录病毒治疗依从性、病毒载量和诊所预约数据将在整个过程中收集， 6个月的随访期。我们假设参与“我的个人健康指南”干预的参与者 将在以下期间显示ART依从性、病毒载量和护理保留率的显著改善- 与对照组参与者相比。我们还将确定移动的电话应用程序的功能， 与依从性的改善相关，以告知应用程序的改进（目标3）。我们 假设更频繁地使用包括激励消息的化身信息功能将 与改善ART依从性相关。这一建议是创新的，因为它开创了一个新的方向， 年轻AAMSM的预防和治疗研究，这是一个治疗失败风险增加的人群， 通过在移动的电话中使用关系谈话的人类化身来克服 耻辱和识字与临床护理的参与。如果我的个人健康指南干预措施是 如果证明是有效的，可以迅速扩大规模，广泛传播。

ABSTRACT: HIV-positive African American men who have sex with men (AAMSM) have the lowest percentage of retention in care and are less likely to have viral suppression, an outcome that relies on antiretroviral therapy (ART) adherence. This proposal focuses on an innovative theory-driven intervention aimed at helping to improve outcomes for AAMSM targeting 3 stages of the HIV Care Continuum, (1) retention, (2) adherence to antiretroviral medication, and (3) viral suppression. My Personal Health Guide is an innovative talking relational human Avatar mobile phone application to engage HIV-positive AAMSM in adherence and retention in care. Development of this app was informed by the Information Motivation Behavioral Skills Model that focuses on feedback between information and motivation that affect one's behavioral skills, behaviors, and desired health outcomes. In the privacy of the user's home or anywhere they have their phone, the Avatar can encourage healthy behavior, acknowledge stigma and speak with empathy, audibly teach persons with low literacy, employ credible culturally appropriate phrasing, and invite the user to hear advice and motivational stories of other HIV-positive people and their caregivers. A pilot study in HIV- positive AAMSM ages 18-34 years demonstrated acceptability, enthusiasm for the app, and preliminary efficacy. As part of a collaboration between UIC, Emory University, and the University of Mississippi Medical Center, we propose to test the efficacy of the My Personal Health Guide Avatar application for young HIV- positive AAMSM. In this 5-year study, the application will be refined based on pilot data (Aim 1) and then 250 HIV-positive AAMSM between the ages of 18-34 years with detectable viral load at baseline will be randomized to the My Personal Health Guide Avatar application or a food safety Avatar application control intervention for a 6-month period (Aim 2). Wirelessly monitored ART adherence will be collected for 1-month at baseline and then wirelessly monitored ART adherence, viral load, and clinic appointment data will be collected throughout the 6-month follow-up period. We hypothesize that participants in the My Personal Health Guide intervention will demonstrate significant improvements in ART adherence, viral load, and retention in care during the follow- up period compared to control participants. We will also identify mobile phone application functions that are associated with improvement in adherence in order to inform refinement of the application (Aim 3). We hypothesize that more frequent use of Avatar information functions that included motivational messages will be associated with improved ART adherence. This proposal is innovative in that it launches a new direction in prevention and treatment research for young AAMSM, a population at increased risk for therapeutic failure and poor retention in care, by using a relational talking human Avatar in a mobile phone to overcome the impact of stigma and literacy on engagement with clinical care. If the My Personal Health Guide intervention is demonstrated to be effective, it may be quickly scaled up for wide-scale dissemination.