HIV-positive African American men who have sex with men (AAMSM) have the lowest percentage of retention in care and are less likely to have viral suppression, an outcome that relies on antiretroviral therapy (ART) adherence. This proposal focuses on an innovative theory-driven intervention aimed at helping to improve outcomes for AAMSM targeting 3 stages of the HIV Care Continuum, (1) retention, (2) adherence to antiretroviral medication, and (3) viral suppression. My Personal Health Guide is an innovative talking relational human Avatar mobile phone application to engage HIV-positive AAMSM in adherence and retention in care. Development of this app was informed by the Information Motivation Behavioral Skills Model that focuses on feedback between information and motivation that affect one's behavioral skills, behaviors, and desired health outcomes. In the privacy of the user's home or anywhere they have their phone, the Avatar can encourage healthy behavior, acknowledge stigma and speak with empathy, audibly teach persons with low literacy, employ credible culturally appropriate phrasing, and invite the user to hear advice and motivational stories of other HIV-positive people and their caregivers. A pilot study in HIV- positive AAMSM ages 18-34 years demonstrated acceptability, enthusiasm for the app, and preliminary efficacy. As part of a collaboration between UIC, Emory University, and the University of Mississippi Medical Center, we propose to test the efficacy of the My Personal Health Guide Avatar application for young HIV- positive AAMSM. In this 5-year study, the application will be refined based on pilot data (Aim 1) and then 250 HIV-positive AAMSM between the ages of 18-34 years with detectable viral load at baseline will be randomized to the My Personal Health Guide Avatar application or a food safety Avatar application control intervention for a 6-month period (Aim 2). Wirelessly monitored ART adherence will be collected for 1-month at baseline and then wirelessly monitored ART adherence, viral load, and clinic appointment data will be collected throughout the 6-month follow-up period. We hypothesize that participants in the My Personal Health Guide intervention will demonstrate significant improvements in ART adherence, viral load, and retention in care during the follow- up period compared to control participants. We will also identify mobile phone application functions that are associated with improvement in adherence in order to inform refinement of the application (Aim 3). We hypothesize that more frequent use of Avatar information functions that included motivational messages will be associated with improved ART adherence. This proposal is innovative in that it launches a new direction in prevention and treatment research for young AAMSM, a population at increased risk for therapeutic failure and poor retention in care, by using a relational talking human Avatar in a mobile phone to overcome the impact of stigma and literacy on engagement with clinical care. If the My Personal Health Guide intervention is demonstrated to be effective, it may be quickly scaled up for wide-scale dissemination.
African American men who have sex with men (AAMSM) have high HIV infection rates, disproportionate mortality, the lowest percentage of retention in care, and a lower likelihood of viral suppression ? an outcome that relies on antiretroviral therapy adherence. We propose to determine the efficacy of ?My Personal Health Guide,? a theory-based innovative talking relational human Avatar mobile phone application to engage HIV- positive AAMSM in adherence and retention in care. Providing an empathetic talking Avatar source of HIV- related information, motivation, and behavioral skills that is as private and convenient as their own mobile phone might produce a high impact by overcoming barriers to HIV adherence and retention in care such as stigma and health literacy.