The candidate is an adolescent medicine specialist and Director of Adolescent HIV Services at The Children's Hospital of Philadelphia with a research focus on using mobile technology to improve adherence and other health outcomes for adolescents at risk for and living with HIV/AIDS. The candidate proposes a career development program that will provide her with the skills and experience to become an independent investigator in the field of adolescent HIV research. In addition to didactic coursework in quantitative and qualitative research methodology and health behavior theory, the candidate's career development will be guided by a multidisciplinary team of nationally recognized advisors committed to her success. [She will form a Technology Advisory Board for mentorship and preceptorships in all aspects of mobile health (mHealth) technology, including incubation and development of technology-based health interventions, study design and analysis techniques for big data/machine learning, gamification theory, user interface/responsive design techniques, usability testing, and the application of health behavior theory to develop mHealth interventions.] Career development activities will be complemented by practical experience gained through the conduct of original research. This proposal examines key health behaviors of medication adherence and sexual risk among young men who have sex with men (YMSM) living with HIV/AIDS, and proposes to develop a mobile phone based intervention targeted at improving these health behaviors in the real times and places youth need support.
AIM 1 will describe the incidence of STI co-infections and virologic failure and report the standardized risk of these outcomes across strata of HIV+ YMSM through retrospective chart review augmented by in-depth structured interviews for further understanding of key psychosocial and behavioral factors. Using focus groups of youth at high- and low-risk, selected based on findings from AIM 1, AIM 2 will explore how HIV+ YMSM use mobile technology, and their attitudes towards various mobile phone-based tools to improve adherence and reduce sexual risk. Delphi methodology will first be used in AIM 3 to convene a panel of mHealth and adolescent health experts to establish consensus guidelines for adolescent sexual health technology-based intervention development. These results, combined with youth input from AIM 2, will serve as a guiding framework for development of a new mHealth secondary prevention intervention for HIV+ YMSM. The new mHealth intervention composed of theory-driven elements, for example, including time and location-based reminders, and individual and group-based gaming incentives will then undergo usability testing consisting of (a) a focus group for specific feedback on design and user experience and then (b) a 12-month feasibility trial where 20 youth will have the application installed and usage, satisfaction, and clinical outcome data will be collected. In line with NIMH's research priorities, this proposal sets out to develop an innovative secondary prevention strategy targeting improved medication adherence and sexual risk reduction among HIV+ YMSM.
The proposed mentored award supports the career development of the candidate into an independent patient- oriented researcher focused on improving the health of adolescents living with and at-risk for HIV/AIDS. The project aims to develop a new secondary prevention intervention, using mobile phone-based technologies, for HIV+ young men who have sex with men (YMSM), targeting key behaviors of sexual risk-taking and poor medication adherence. This research is highly relevant to public health as it targets improving health outcomes of HIV+ youth and preventing new infections among YMSM who are most disproportionately affected by the HIV epidemic in the US.