Mulawa Marta I, Rosengren A Lina, Amico K Rivet, Hightow-Weidman Lisa B, Muessig Kathryn E
School of Nursing, Duke University, Durham, NC, USA.
Duke Global Health Institute, Duke University, Durham, NC, USA.
Mhealth. 2021 Apr 20;7:35. doi: 10.21037/mhealth-20-68. eCollection 2021.
Multiple intersecting stigmas and discrimination related to sex, gender, HIV, and race/ethnicity may challenge HIV prevention and treatment service utilization, particularly among youth. This scoping review describes recent and ongoing innovative mobile health (mHealth) interventions among youth in the United States that aim to reduce stigma as an outcome or as part of the intervention model. To identify examples of stigma-mitigation via mHealth, we searched peer-reviewed published literature using keyword strategies related to mHealth, HIV, stigma, and youth (ages 10 to 29). We identified eleven articles that met our inclusion criteria, including three describing data from two randomized controlled trials (RCTs), five describing pilot studies, one describing the process evaluation of an ongoing intervention, one describing formative work for intervention development, and one published study protocol for an ongoing intervention. We review these articles, grouped by HIV prevention and care continuum stages, and describe the mHealth approach used, including telehealth, simulation video games, motion comics, smartphone applications (apps), social media forums, online video campaigns, video vignettes, and a computerized behavioral learning module. Four studies focused on preventing primary acquisition through individual-level behavior change (e.g., reducing condomless anal intercourse), three focused on increasing HIV testing, three focused on linking to prevention services [e.g., pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)] and one focused on promoting adherence to antiretroviral therapy (ART). Our review did not identify any published studies using mHealth with a primary aim to reduce stigma as a way to improve care engagement and increase viral suppression among youth in the United States. Additional RCTs and implementation studies examining the effectiveness of mHealth stigma-reduction interventions on HIV-related outcomes are needed to end the HIV epidemic among youth. mHealth offers unique advantages to address the complex intersecting stigma barriers along the HIV continuum to improve HIV-related outcomes for youth.
与性别、性取向、艾滋病毒及种族/族裔相关的多重交叉污名和歧视可能会对艾滋病毒预防和治疗服务的利用构成挑战，在青少年中尤为如此。本范围综述描述了美国青少年中近期及正在开展的创新移动健康（mHealth）干预措施，这些干预措施旨在将减少污名作为一项成果或作为干预模式的一部分。为了确定通过移动健康减轻污名的实例，我们使用与移动健康、艾滋病毒、污名和青少年（10至29岁）相关的关键词策略，检索了同行评审的已发表文献。我们确定了11篇符合纳入标准的文章，其中3篇描述了两项随机对照试验（RCT）的数据，5篇描述了试点研究，1篇描述了一项正在进行的干预措施的过程评估，1篇描述了干预措施开发的形成性工作，还有1篇是一项正在进行的干预措施的已发表研究方案。我们按艾滋病毒预防和护理连续阶段对这些文章进行了分组回顾，并描述了所使用的移动健康方法，包括远程医疗、模拟视频游戏、动态漫画、智能手机应用程序（应用）、社交媒体论坛、在线视频活动、视频短片以及一个计算机化行为学习模块。四项研究侧重于通过个人层面的行为改变预防初次感染（例如，减少无保护肛交），三项研究侧重于增加艾滋病毒检测，三项研究侧重于与预防服务建立联系[例如，暴露前预防（PrEP）和暴露后预防（PEP）]，一项研究侧重于促进对抗逆转录病毒疗法（ART）的依从性。我们的综述未发现任何以减少污名为主要目的、使用移动健康来改善美国青少年护理参与度并提高病毒抑制率的已发表研究。需要开展更多随机对照试验和实施研究，以检验移动健康减少污名干预措施对艾滋病毒相关结局的有效性，从而在美国青少年中终结艾滋病毒流行。移动健康具有独特优势，可解决艾滋病毒连续过程中复杂的交叉污名障碍，以改善青少年的艾滋病毒相关结局。
