The Role of an Artificially Intelligent Chatbot in Social Support, Antiretroviral Adherence, and Depressive Symptoms among Young Adults Living with HIV in South Africa

项目总结 具体目标：制定有效的干预措施，以减少男女之间治疗结果的差异 受艾滋病毒影响不成比例的人口是NIH资助的2019年艾滋病毒研究的优先事项。这项研究将 探索人工智能、支持社交的聊天机器人--一种可以发送文本的计算机--的效果和接受情况 通过移动电话使用--感染艾滋病毒的年轻女性和男男性行为者(YMSM) 在南非。具体地说，这项研究将(1)开发一个在线量表来衡量聊天机器人的社会支持 在年轻人中；(2)评估来自聊天机器人的社会支持与抑郁变化的关联 南非年轻女性和YMSM的症状和抗逆转录病毒疗法(ART)的依从性；以及 (3)描述南非年轻女性和基督教青年会接受聊天机器人的障碍和促进者。 意义：15至24岁的年轻南非人感染和死亡的风险很高 感染了艾滋病毒。尽管艺术可以延长寿命并防止传播，但许多年轻人对此的坚持程度很低。 高收入国家的研究表明，与聊天机器人进行自动双向消息传递可以提高 坚持健康行为。聊天机器人还可以解决抑郁症状和缺乏社会支持的问题， 这些一直被认为是遵守的障碍。聊天机器人很少被用来改善低收入国家的艾滋病毒护理 和中等收入国家。如果这项研究的目的达到了，那么(1)未来的研究人员将能够 准确衡量聊天机器人的社会支持；(2)聊天机器人可能被用来促进忠诚度 提供药物并增加获得精神卫生支持的机会；以及(3)未来设计和实施 改善艾滋病毒护理的聊天机器人将得到优化。这项研究的长期目标是为 有效、可扩展的干预措施，使难以接触到的艾滋病毒携带者群体参与其中。 方法：目标1将开发一个量表，使用主成分来衡量聊天机器人的社会支持 探索性因素分析应用于从全球1200名使用Replika的年轻人收集的数据， 免费提供的移动应用程序(APP)。AIMS 2和AIMS 3将邀请160名年轻女性和与 南非开普敦的HIV患者在研究前的设计中使用Replika应用程序四周。目标2将 使用广义多变量线性回归模型进行协方差分析来评估 Replika应用程序的社会支持感受与抑郁症状和抑郁症状变化的关系 艺术坚守。目标3将以混合方法利用调查(定量)和访谈(定性) 研究应用程序高参与度和低参与度用户之间的差异。 奖学金信息：这项研究是为博士生布鲁克·贾勒特女士撰写的 约翰霍普金斯大学流行病学系。她的培训将包括研究方法和 科学传播朝着成为最先进的移动设备研究人员的职业目标迈进 改善受健康差距影响的年轻人的身心健康的技术。

PROJECT SUMMARY Specific Aims: Developing effective interventions to reduce disparities in treatment outcomes among populations disproportionately affected by HIV is a priority for NIH-funded HIV research in 2019. This study will explore the effects and uptake of an artificially intelligent, socially supportive chatbot – a computer that texts with users via mobile phone – among young women and men who have sex with men (YMSM) living with HIV in South Africa. Specifically, the study will (1) develop an online scale to measure social support from a chatbot among young adults; (2) evaluate associations of social support from a chatbot with changes in depressive symptoms and adherence to antiretroviral therapy (ART) among young women and YMSM in South Africa; and (3) describe barriers and facilitators to uptake of a chatbot among young women and YMSM in South Africa. Significance: Young South Africans between the ages of 15 to 24 are at high risk of contracting and dying from HIV. Though ART extends life and prevents transmission, many young adults have poor adherence. Research in high-income countries suggest that automated two-way messaging with chatbots improves adherence to health behaviors. Chatbots may also address depressive symptoms and lack of social support, which are consistently identified barriers to adherence. Chatbots are rarely used to improve HIV care in low- and middle-income countries. If this study’s aims are achieved, then (1) future researchers will be able to more accurately measure social support from chatbots; (2) chatbots could potentially be used to promote adherence to medications and increase access to mental health support; and (3) future design and implementation of chatbots to improve HIV care will be optimized. This study’s long-term objective is to generate evidence for an effective, scalable intervention that engages hard-to-reach populations living with HIV. Approach: Aim 1 will develop a scale to measure social support from a chatbot using principal components and exploratory factor analyses applied to data gathered from 1,200 young adults worldwide who use Replika, a freely available mobile application (app). Aims 2 and 3 will invite 160 young women and YMSM living with HIV in Cape Town, South Africa to use the Replika app for four weeks in a pre-post study design. Aim 2 will employ an analysis of covariance using generalized multivariable linear regression models to assess the relationship between feelings of social support from the Replika app and changes in depressive symptoms and ART adherence. Aim 3 will leverage surveys (quantitative) and interviews (qualitative) in a mixed methods study to characterize differences between users with high- and low-frequency engagement with the app. Fellowship Information: This study is the dissertation for Ms. Brooke Jarrett, a PhD student in the Department of Epidemiology at Johns Hopkins University. Her training will consist of research methods and science communication toward her career goal of becoming a researcher of state-of-the-art mobile technologies to improve the physical and mental health of young people affected by health disparities.