LetSync: An mHealth approach to HIV care engagement among black men in couples

项目总结/摘要 根据目前的诊断率，每两个黑人男性与男性发生性关系（BMSM）将被诊断为 艾滋病病毒在一生中采取干预措施，以最大限度地保留护理和坚持抗逆转录病毒疗法 (ART)在BMSM中，迫切需要减少艾滋病毒种族差异。二元干预方法是 有希望，因为近一半的BMSM感染艾滋病毒是在主要的关系，并符合 呼吁研究与BMSM关注超越个人水平。我们对BMSM的初步研究 夫妇发现，主要关系往往是满足艾滋病毒护理需求的主要资源 订婚BMSM夫妇参与联合解决问题和护理的二元协调， 同步和共同组织围绕治疗和护理的时间表、活动和行为。我们也 发现，在护理参与中的二元协调和联合解决问题可能更常见于 BMSM夫妇有更大的夫妇的韧性，定义为夫妇的能力，以克服共同的逆境 缓冲社会和结构因素对BMSM健康和福祉的压力。基于我们 在前期工作和现有研究的基础上，我们建立了一个艾滋病护理参与的理论框架 来指导这项研究。智能手机在不同年龄和社会经济背景的BMSM中无处不在 背景，和移动的技术的健康（mHealth）是可行的，可接受的，和有效的艾滋病毒 BMSM的干预措施。我们已经开发了BMSM夫妇为重点的干预的初步设计 应用程序（app），LetSync，以提高护理保留率和ART依从性。BMSM夫妇表现出很好的 对这种方法感兴趣。然而，关键问题仍然存在，例如需要更深入地了解如何 二元过程相互关联，以加强二元能力，如何在移动健康干预中将其作为目标， 以及需要引导干预组件和功能。因此，本R01的目标如下。 目标1将涉及调查艾滋病毒护理参与中相互关联的二元过程（夫妇的弹性，联合 解决问题，二元协调），通过深入采访BMSM在12个血清一致性阳性 和12对血清不一致夫妇（24对，N = 48）由我们的概念框架指导。Aim 2将开发一个 通过迭代应用程序，通过Aim 1和我们之前的mHealth设计了解夫妇的mHealth干预 与BMSM夫妇的社区咨询理事会和应用程序原型的迷你试点一起开发， 干预方案和程序目标3将需要一个随机的，等待名单控制的试点试验，80 夫妇（N = 160），以评估其可接受性，可行性和对护理和ART保留的初步影响 通过毛发中的抗逆转录病毒浓度测量粘附性。拟议研究的结果是 这对于为随后的全面随机对照试验提供信息至关重要，该试验旨在测试LetSync在改善艾滋病毒护理方面的疗效， BMSM夫妇的治疗结果，以减少美国艾滋病毒种族差异

PROJECT SUMMARY/ABSTRACT Based on current diagnoses rates, one in two Black men-who-have-sex-with-men (BMSM) will be diagnosed with HIV during their lifetime. Interventions to optimize retention in care and adherence to antiretroviral therapy (ART) among BMSM are urgently needed to reduce HIV racial disparities. Dyadic intervention approaches are promising, given that nearly half of BMSM living with HIV are in primary relationships, and are consistent with calls for research with BMSM to focus beyond the individual level. Our preliminary research with BMSM in couples finds that the primary relationship is often the main resource in meeting needs in HIV care engagement. BMSM couples engage in joint problem-solving and dyadic coordination of care that entail synchronizing and co-organizing schedules, activities, and behaviors around treatment and care. We also found that dyadic coordination and joint problem-solving in care engagement may be more common among BMSM couples with greater couple’s resilience, defined as the couple’s capacity to overcome shared adversity that buffers against the strains of social and structural factors on health and wellbeing for BMSM. Based on our preliminary work and extant research, we developed a theoretical Framework of Dyadic HIV Care Engagement to guide this research. Smartphones are ubiquitous among BMSM of various ages and socioeconomic backgrounds, and mobile technology for health (mHealth) is feasible, acceptable, and effective as HIV interventions among BMSM. We have developed initial designs for a BMSM-couple-focused intervention application (app), LetSync, to improve retention in care and ART adherence. BMSM couples showed a great interest in this approach. However, critical issues remain, such as the need for a deeper understanding of how dyadic processes interrelate to bolster dyadic capacity, how they may be targeted in an mHealth intervention, and the need for piloting intervention components and features. As such, the aims to this R01 are as follows. Aim 1 will involve investigating interrelated dyadic processes in HIV care engagement (couple’s resilience, joint problem-solving, dyadic coordination) through in-depth interviews with BMSM in 12 seroconcordant-positive and 12 serodiscordant couples (24 couples, N=48) guided by our conceptual framework. Aim 2 will develop a couple’s mHealth intervention informed by Aim 1 and our prior mHealth designs, through iterative app development with a community advisory council of BMSM couples and a mini-pilot of the app prototype, intervention protocols, and procedures. Aim 3 will entail a randomized, waitlist-controlled pilot trial with 80 couples (N=160) to assess its acceptability, feasibility, and preliminary impact on retention in care and ART adherence as measured by antiretroviral concentrations in hair. Findings from the proposed research are critical for informing a subsequent full-scale RCT to test the efficacy of LetSync in improving HIV care and treatment outcomes among BMSM couples toward reducing HIV racial disparities in the U.S.