A social media mHealth intervention to improve retention in care for adolescents and young adults with HIV in Uganda

项目摘要/摘要 背景：只有约50%的青少年和青壮年艾滋病毒携带者(AYWH)启动艾滋病毒护理 在12个月大的时候接受护理。此外，2020年，妇幼保健院记录的艾滋病相关死亡率增加了50%。这些可怜的人 临床结果是多因素的，并严重影响他们的神经发育阶段和途径 感染(围产期与非围产期)。目前对留住老年妇女医院的干预措施是有限的，而且没有解决 爱滋病医院艾滋病毒护理的这些关键方面。基于社交媒体的移动健康(MHealth)干预提供灵活的 和吸引人的特点，以帮助克服保留护理的障碍。候选人：目标是 拟议的K43新兴全球领导者奖是为了支持朱利安·阿东博士的研究培训，以实现 作为一名临床科学家，独立致力于改善低资源条件下AYWH的治疗和护理 设置。阿东博士目前是乌干达姆巴拉拉科技大学的研究员。 拟议的研究将有助于在三个领域进行培训：1)定性和混合方法研究，包括 设计、数据收集、分析和解释；2)行为科学技能，更好地理解影响 青少年行为及其对基于移动健康的干预措施的制定和部署的影响；以及3) 临床试验的统计方法，包括纵向数据分析。此应用程序构建在阿东博士的 流行病学方面的当前临床经验和背景，以及移动健康领域正在形成的工作 干预性发展。研究：本方案的研究目标是开发和测试可行性 青少年量身定做的基于社交媒体的mHealth干预措施改善HIV滞留的可接受性 关爱爱华会。干预将受到社会认知理论和计划理论的启发 行为，开发过程将由IDEAS框架指导。首先，阿东博士将定义 妇幼保健院新员工或新员工面临的认知、环境和行为挑战 HIV护理，通过神经发育阶段和感染途径表征这些因素及其对 行为意向(目标1)。然后，她将利用AYWH和临床的投入反复开发干预措施 辅导员(目标2)。最后，她将测试该方案的可接受性、可行性和初步有效性 通过一项试验性等待名单对照试验对新入院或住院病人进行为期一年的护理干预 最近重新从事艾滋病毒护理(目标3)。创新：这项研究将是第一次讨论 神经发育阶段和感染途径，以保持护理，并将利用强大的潜力 接受移动健康的人群中的移动健康干预。未来方向：阿东博士的研究和 培训目标得到了由专职导师组成的多学科团队的良好协调和支持。在结束时， 获奖后，她将成为R01应用程序的优秀候选人，以最终评估mHealth干预措施 在资源匮乏的环境下改善老年妇女医院的艾滋病毒治疗结果。

PROJECT SUMMARY/ABSTRACT Background: Only about 50% of adolescents and young adults with HIV (AYWH) who initiate HIV care remain in care at 12 months. Moreover, in 2020, AYWH recorded a 50% increase in AIDS-related mortality. These poor clinical outcomes are multi-factorial and heavily influenced by their neurodevelopmental stage and by route of infection (perinatal vs non-perinatal). Current interventions to retain AYWH in care are limited and do not address these key aspects of HIV care for AYWH. Social media-based mobile health (mHealth) interventions offer flexible and attractive features to AYWH to help overcome barriers to retention in care. Candidate: The goal of the proposed K43 Emerging Global Leader Award is to support Dr. Julian Adong’s research training to attain independence as a clinician-scientist focused on improving treatment and care for AYWH in low resourced settings. Dr. Adong is currently a research fellow at Mbarara University of Science and Technology, Uganda. The proposed study will enable training in three areas: 1) Qualitative and mixed methods research, including design, data collection, analysis and interpretation; 2) Behavioural science skills to better understand influences of adolescent behaviour and implications for mHealth-based intervention development and deployment; and 3) Statistical methods for clinical trials, including longitudinal data analysis. This application builds on Dr, Adong’s current clinical experience and background in epidemiology, as well as ongoing formative work in mHealth intervention development. Research: The research goals of this proposal are to develop and test the feasibility and acceptability of an adolescent-tailored social media-based mHealth intervention to improve retention in HIV care for AYWH. The intervention will be informed by Social Cognitive Theory and the Theory of Planned Behaviour, and the development process will be guided by the IDEAS Framework. First, Dr. Adong will define the cognitive, environmental, and behavioural challenges among AYWH who are new or newly re-engaging in HIV care, characterizing these factors by neurodevelopmental stage and route of infection and their impact on behavioural intention (Aim 1). She will then iteratively develop the intervention with input from AYWH and clinic counsellors (Aim 2). Finally, she will test the acceptability, feasibility, and preliminary effectiveness of the intervention on one-year retention in care through a pilot wait-list controlled trial among AYWH who are new or newly re-engaging in HIV care (Aim 3). Innovation: This study will be the first to address the important role of neurodevelopmental stage and route of infection for retention in care and will leverage the strong potential of mHealth interventions in this mHealth-receptive population. Future directions: Dr. Adong’s research and training aims are well aligned and supported by a multidisciplinary team of dedicated mentors. At the end of the award, she will be an excellent candidate for an R01 application to definitively assess mHealth interventions to improve HIV treatment outcomes among AYWH in low resourced settings.