Responding to high rates of HIV/AIDS among opiate users, China has recently implemented methadone maintenance treatment (MMT) programs in order to reduce HIV risks among injection drug users (IDUs). While China has made strides in the implementation of MMT, high rates of continued opiate use and dropout among MMT patients remain problematic. Improved self-monitoring and self-management are important elements in chronic disease management, but these concepts are relatively new to Chinese MMT providers and patients. According to cognitive behavioral theories, managing triggers/risks and building coping skills are critical in relapse prevention and sustained recovery. A better understanding of common triggers and effective coping strategies among MMT patients will provide a foundation for developing effective interventions. Communication technologies and the proliferation of cellphones in China provide great opportunities to engage and network with patients and to collect ecological momentary assessment (EMA) data on triggers and coping responses. The proposed project will test the feasibility and acceptability of EMA data collection of triggers and coping responses using cellphone and text messaging technology. An open-source mobile health platform, called "ANDWellness," has been developed by UCLA researchers for supporting self-monitoring and behavioral interventions. We propose to build upon this innovative platform to conduct real-time assessment of triggers and coping responses among MMT patients in China. The study aims are (1) To develop an interactive cellphone-supported mobile health prototype that establishes individualized profiles of risks or triggers and that supports knowledge and skill building, including coping strategies;and (2) To conduct a pilot study to assess the reliability and validity of the EMA data. A secondary objective is to obtain preliminary evidence on self-monitoring in relation to outcome data (e.g., MMT retention, abstinence). The project will be accomplished in two phases: Phase I will develop a smartphone-based prototype of the ANDWellness application. We will also assess the acceptability and feasibility of the prototype. Phase II will consist of a pilot test to examine th acceptability of and compliance with the ANDWellness prototype collecting EMA data on triggers and responses, the correspondence of EMA with the retrospective recall and urine testing, and the relation between EMA and some limited outcomes. These pilot efforts will prepare us for future intervention development based on cellphone technology. The long-term goal of this line of research is to develop promising strategies that optimize treatment effectiveness and support sustained recovery by taking advantage of the popularity of cellphone use, and adapting and applying evidence-based principles to address drug use and HIV/HCV risk behaviors. Thus, the study will contribute to the literature on triggers and coping strategies and will extend NIDA's mission of promulgating research-based interventions to improve treatment services and reduce HIV/HCV transmission globally.
Addressing the linked problems of drug use and HIV/AIDS in China will decrease the spread of these conditions and related consequences worldwide. The study is unique and important because it will develop a novel data collection tool that is built upon innovative mobile health technologies to identify triggers and coping strategies. Knowledge generated can be used to develop interventions appropriate for MMT patients in Chinese communities to help address this important public health problem in China and globally.