PositiveLinks for Youth and Emerging Adults (PL4Y): Adapting a multimodal evidence-based mHealth intervention to increase engagement in HIV care in the Southern US

项目摘要 18- 29岁（YLWH）的新成年人和青年艾滋病毒感染者是任何年龄组中最不可能参与的人。 护理或实现病毒学抑制，南部YLWH生活在现代美国艾滋病毒的中心 疫情在得克萨斯州，年轻人中艾滋病毒快速传播的分子簇突出了错过的机会 包括护理参与和病毒学抑制的延迟，以及我们目标中不到20%的YLWH 南德克萨斯州的人口实现病毒学抑制。我们的长期目标是提高 通过开发一种用于护理参与的新型移动的健康（mHealth）工具来抑制YLWH。 移动健康干预措施，如智能手机应用程序（app），迅速被年轻人采用， 未充分利用的资源，以增加对YLWH的护理参与。本项目拟进行调整和试点测试 由迪灵厄姆和英格索尔开发的现有移动健康工具PositiveLinks Program（PL）的有效性 （Co-Is）。Pl是一种多模式干预，包括每日依从性评估、预约提醒、安全 与诊所提供者的消息传递，以及在线匿名同行支持网络。PL增加护理 在观察性研究中，艾滋病毒感染成人（大多数> 40岁）的参与和病毒学抑制，但没有 在YLWH学习。泰勒（PI）、尼哈万（Co-I）和比利亚雷亚尔（Co-I）的形成性研究表明， 得克萨斯州的患者和提供者寻求关系干预，YLWH要求mHealth方法， 订婚我们将使用计划行为理论（TPB）作为理论模型， 开发（PYD）作为一种严格适应和试点测试PL修改版本的方法，PositiveLinks 青年（PL 4 Y）。 为此，我们将对PositiveLinks进行严格的形成性评估，以使其适应YLWH的需求， 包括：由TPB告知的与YLWH经历护理挑战的半结构化访谈 参与和利益攸关方，以及青年咨询委员会的反馈（目标1）。我们将继续发展， 迭代地调整PL的组成部分和新的以青年为重点的组成部分， 新诊断的、脱离护理的或未使用病毒学抑制的YLWH评估 以人为本的设计方法，由PYD提供信息，以生成青少年积极联系（PL 4 Y）（目标2）。 最后，我们将在YLWH进行一项小型试点随机对照试验，以适应PL 4 Y计划 脱离或新从事艾滋病毒护理，以评估其对病毒学抑制的影响（目标3）。混合 方法过程评价将评估这种新干预的可接受性和可行性。 通过这些目标，我们将开发一个创新的护理参与工具，以满足发展和 YLWH的社会/结构需求。我们的方法可以作为有效适应移动健康的模式 为满足社区的迫切需要，对新的目标受众进行干预。

Project Summary Emerging adults and youth living with HIV 18-29yo (YLWH) are the least likely of any age group to engage in care or achieve virologic suppression, and Southern YLWH live at the epicenter of the modern U.S. HIV epidemic. In Texas, molecular clusters of rapid HIV transmission among youth highlight missed opportunities including delays in care engagement and virologic suppression, and less than 20% of YLWH in our target population in South Texas achieve virologic suppression. Our long-term goal is to improve rates of virologic suppression for YLWH through development of a novel mobile health (mHealth) tool for care engagement. mHealth interventions, such as smartphone applications (apps), are rapidly adopted by youth, and are an underutilized resource in increasing care engagement for YLWH. This project proposes to adapt and pilot test the efficacy of an existing mHealth tool, the PositiveLinks Program (PL), developed by Dillingham and Ingersoll (Co-Is). Pl is a multimodal intervention, including daily adherence assessment, appointment reminders, secure messaging with clinic providers, and an online anonymized peer support network. PL increased care engagement and virologic suppression in adults (majority >40yo) with HIV in observational studies, but has not been studied in YLWH. Formative research by Taylor (PI), Nijhawan (Co-I), and Villarreal (Co-I) showed that patients and providers in Texas seek relational interventions and YLWH request mHealth approaches for engagement. We will use the Theory of Planned Behavior (TPB) as a theoretical model and Positive Youth Development (PYD) as an approach to rigorously adapt and pilot test a modified version of PL, PositiveLinks for Youth (PL4Y). To do so, we will conduct a rigorous formative evaluation of PositiveLinks to adapt it to the needs of YLWH, including: semi-structured interviews informed by TPB with YLWH experiencing challenges with care engagement and stakeholders, and feedback from a Youth Advisory Board (Aim 1). We will then develop and iteratively adapt components of PL and new youth-focused components emerging from the formative evaluation with YLWH who are newly diagnosed, disengaged in care, or not virologically suppressed using a human-centered design approach informed by PYD to generate PositiveLinks for Youth (PL4Y) (Aim 2). Finally, we will conduct a small pilot randomized control trial of the adapted PL4Y program in YLWH disengaged from or newly engaging in HIV care to assess its impact on virologic suppression (Aim 3). A mixed methods process evaluation will assess acceptability and feasibility of this novel intervention. Through these aims we will develop an innovative care engagement tool that caters to the developmental and socio/structural needs of YLWH. Our approach can serve as a model for efficient adaptation of mHealth interventions to new target audiences in response to an urgent community need.