Text Messaging Adherence Assessment & Intervention Tool for Rural HIV+ Drug Users

描述（由申请人提供）：这是PAS-10-098，基于技术的药物滥用人群的依从性干预（R34）下的新申请。吸毒者、少数民族和居住在主要大都市地区以外、健康状况较差的妇女需要新的方法来促进坚持艾滋病毒治疗。人们熟悉的技术设备，如移动电话，可以克服农村艾滋病毒阳性患者之间的一些健康差距。在这个项目中，研究人员将开发和测试一种短信系统的可行性和前景，该系统使用生态瞬间评估（EMA）方法来检测不依从性和吸毒事件，然后立即进行干预，以提高艾滋病毒/艾滋病吸毒者的艾滋病毒治疗依从性（包括药物依从性和治疗参与度）。通过对目标患者的形成性研究，并与技术开发商合作，我们将开发应用和管理系统，即文本治疗扩展（Text）。文本将评估常规依从性，允许用户报告关键事件，并响应关于依从性，药物使用和药物渴望的随机定时查询。当文本EMA应用程序检测到对依从性的威胁时，它将提供由参与者选择的个性化定制干预文本消息。这些定制信息将提醒用户按时服药，减少吸毒。研究人员将在一项小型随机试验中对新的依从性工具进行为期三个月的试验，以确定Text的可行性、可接受性和前景。这个R34是行为治疗发展阶段模型的1b/2a阶段项目，因为它将开发新的干预措施和方法，并产生效应大小的初步估计，这将决定是否有必要进行更大、更昂贵的临床试验，并进行更长的随访期和成本效益评估。通过使用技术实时评估和检测不遵医嘱、药物使用和药物渴望的情况，该项目将及时提供“即时”干预，帮助患者在健康损害发生之前恢复药物依从性。如果成功，Text有可能迅速扩大规模，在美国农村地区进行进一步的试验。

DESCRIPTION (provided by applicant): This is a new application under PAS-10-098, Technology-based Adherence Interventions for Substance Abusing Populations with HIV (R34). New methods to promote HIV treatment adherence are needed for drug users, ethnic minorities, and women, who reside outside major metropolitan areas who have worse health outcomes. Familiar technological devices such as mobile phones could overcome some of the health disparities seen among rural HIV+ patients. In this project, investigators will develop and test the feasibility and promise of a text messaging system that uses Ecological Momentary Assessment (EMA) methods to detect nonadherence and drug use episodes, then immediately intervenes to improve HIV treatment adherence (both medication adherence and treatment engagement) in drug users living with HIV/AIDS. Using formative research with the targeted patients and partnership with a technology developer, we will develop the application and administrative system, Treatment Extension by Text (Text). Text will assess routine adherence, allow users to report critical events, and respond to randomly timed queries about adherence, drug use, and drug craving. When the Text EMA application detects threats to adherence, it will deliver a personalized, tailored intervention text message chosen by the participant. These customized messages will remind the user to take medications on time and reduce drug use. Investigators will pilot test the new adherence tool against treatment as usual over a three month period in a small pilot randomized trial to determine the feasibility, acceptability, and promise of Text. This R34 is a Stage 1b/2a project in the Stage Model of Behavioral Therapy Development in that it will develop novel interventions and methods, and generate preliminary estimates of effect sizes that will determine whether a larger, more expensive clinical trial with a longer follow-up period and evaluation of cost-effectiveness is warranted. By using technology to assess and detect episodes of nonadherence, drug use, and drug craving in real time, the project will deliver an intervention "on the fly" in time to help the person resume medication adherence before health damages occur. If successful, Text has the possibility of rapid scale-up for further trials across the rural U.S. to follow. PUBLIC HEALTH RELEVANCE: This project will develop and pilot test a text messaging system for mobile phones to assess HIV treatment adherence, quickly detect problems as they occur, and send personalized intervention messages to help rural and non-urban drug using patients achieve HIV medication adherence and interrupt drug use. This intervention could be scaled up quickly as a novel, sustainable approach to maintaining treatment adherence. Lessons learned could hasten the development of interventions for other chronic diseases in the U.S.