应用mHealth提高HIV/AIDS患者疾病自我管理和健康结局的可行性及有效性研究

Human Immunodeficiency Virus (HIV) has been widely recognized as a chronic disease. The number of people living with HIV/AIDS (PLWHA) has been increasing over the years in China. There is a great need for PLWHA to have self-management program to improve their health outcomes and to prevent HIV transmission. However, there is a lack of research on self-management among PLWHA in China and the existing health infrastructure is in shortage of necessary resources to provide traditional self-management services for PLWHA. Based on international and domestic evidence-based successful self-management experiences and situated in China with widely usage of mobile phone, the current study is the first effort to innovatively employ mobile technology and develop mobile app and information platform (mHealth) to explore the feasibility and efficacy of using mHealth to provide patient-centered individualized self-management services for PLWHA. Guided by social cognitive theory and social ecological theory, the current study will use mixed methods of both in-depth interviews and randomized controlled trial (RCT) with repeated measurements. Key individual and social factors that have significant impact on patients’ HIV treatment-related behavior and health outcomes are identified, including HIV-related knowledge, self-efficacy and social support, and corresponding intervention strategies are developed for the purposes of improving patients’ HIV treatment-related behavior and health outcomes. Findings of this study will have important theoretical and practical implications for HIV treatment, public health, health management and policy making in China.

目前艾滋病已被公认为是一种慢性疾病，我国HIV/AIDS患者总量逐年递增，需要长期的慢性病自我管理，提高患者健康水平和预防HIV二代传播。但是我国缺乏对HIV/AIDS患者进行自我管理的研究，而且现有医疗体系也缺乏提供传统自我管理服务的资源。本研究适应我国手机日益普及的国情，首次创新性的利用和开发移动技术（手机、应用程序和信息平台，mHealth），借鉴国内外成功的慢性病自我管理经验，探索利用mHealth为HIV/AIDS患者提供个性化自我管理服务的可行性和有效性。本研究以社会认知和社会生态学理论为指导，结合定性访谈和重复测量随机对照干预试验的研究方法，对个人和社会层面影响HIV治疗行为和健康结局的关键因素（HIV相关知识、自我效能、社会支持）进行针对性的干预，改善患者HIV治疗行为和提高健康水平。研究结果对中国HIV治疗、公共卫生管理和政策制定都具有重要的理论和实践意义。

我国HIV/AIDS患者总量逐年递增，需要长期的慢性病自我管理，提高患者健康水平和预防HIV二代传播。但是我国缺乏对HIV/AIDS患者进行自我管理的研究，而且现有医疗体系也缺乏提供传统自我管理服务的资源。约一半的HIV/AIDS患者有不同程度的抑郁症状，极大影响患者的总体健康水平和生存质量。本研究适应我国手机日益普及的国情，首次创新性的利用和开发移动技术（mobile health, mHealth），借鉴国内外成功的慢性病自我管理经验，探索利用mHealth提高HIV/AIDS患者的心理健康进而改善患者生存质量的干预的可行性与有效性。. 本研究是样本量为300的随机对照试验，对干预组150名HIV/AIDS患者进行三个月的干预，并对所有患者进行了为期9个月的随访。主要干预内容包括心理提升培训和锻炼干预两部分。心理提升培训内容根据国外针对HIV/AIDS 患者人群进行面对面心理干预证实有效的认知行为压力管理课程(Cognitive-Behavior and Stress Management, CBSM)，结合我国国情和该人群的特点进行开发改进。另外，开展动机式访谈，帮助患者设定科学锻炼目标进行锻炼干预并自动提醒和反馈患者锻炼情况。. 随机对照试验取得了显著而持久的效果。相对于对照组，干预组的抑郁水平显著降低，生存质量显著提高以及其它多项社会心理指标都得到了明显改善，比如耻辱感、自我效能、压力等，并且这种显著效果在干预结束后6个月仍继续维持。七篇英文文章成果发表在mHealth排名第一、第二的杂志（JMIR、JMIR mHealth and uHealth）以及BMC public health等，还有两篇英文文章成果已经投稿。另外，本项目研究结果也在本研究结果也在多个国际国内会议上作为口头汇报或海报展示。. 本研究是全球范围内首个利用mHealth（社交媒体平台）对HIV/AIDS患者心理健康干预的研究，研究的结果为提高HIV/AIDS患者心理健康提供了理论和实证基础，填补了我国 HIV/AIDS 患者心理干预创新模式和内容的空白，突破传统心理干预的瓶颈，提供了具有潜在经济和规模效益的干预模式，降低成本，创造性地解决我国医疗资源短缺问题。研究成果可以纳入HIV日常管理模式，对中国及国际上艾滋病治疗、公共卫生、卫生管理和政策制定都具有重要的理论和实践意义。