Tough Talks: A Disclosure Intervention for HIV+ YMSM

PROJECT SUMMARY Men who have sex with menMSMaccount for nearly two thirds all of new HIV infections in the United StatesUSand young MSMYMSMare the only risk group experiencing a significant increase in HIV incidenceAmong youthpercent report not disclosing to their first time sex partnersDisclosing of one s HIV status is important for accessing support which can lead to improved medication adherence and retention in careThose who disclose are more likely to use condoms with uninfected sex partnersand mathematical modeling estimates that increased HIV status disclosure to sex partners may reduce transmissions byFurtherdisclosure may motivate uninfected sex partners to seek testing and reduce their own HIV transmission behaviorsGiven the potential benefits and challenges associated with disclosurethere is a need for sophisticated interventions that can assist MSMwith the disclosure processVirtual reality provides a unique environment for users to practice HIV disclosureArtificial intelligenceAIdriven disclosure may offer advantages over in person role play through the use of realistic avatars that represent potential romantic partnersand probabilistic settings where users envision having disclosure conversationsUsers have the opportunity to practice disclosing and experience a variety of responses and outcomesDuring Phase I of this project we developed an iPad based virtual reality system that features three avatarstwo virtual locations and three disclosure scenarios which represent a variety of common disclosure experiences and contexts experienced by YMSMIn Phase II we will further enhance Tough Talks and develop a full feature automated version to test via a multi siterandomized controlled trialRCTthrough the newly created Center for Innovative TechnologiesiTechacross the Prevention and Care Continuuman NIH funded center to support adolescent HIV researchThe aims of this Phase II SBIR areRefine and enhance the current Tough Talks disclosure scenarios to include additional contentcharacters and virtual environmentsFormative work with YMSMagedyearswill inform development and we will work with a leader in AI software to incorporate natural language into the AI driven scenariosDevelop the Tough Talks stand alone interventionThis fully automated intervention will include the AI driven disclosure scenarios created in aimas well as a virtual disclosure coach to guide participants through the intervention goal setting interactive exercises and interactive educational videosFollowing developmenta technical pilot to optimize functionality and technical performance will be conducted withYMSM andConduct a three arm combined efficacy effectiveness trial to compare the intervention delivered onlineArmversus in the clinicArmcompared to standard of careSOCdisclosure messaging onlyPrimary outcomes of HIV viral load and condomless anal intercourseCAIwill be assessed at intervention completionmonthand atmonth follow upWe will estimate transmissions averted and program costs of each armMonthsPROJECT NARRATIVEDespite monumental advances in HIV treatment and prevention technologiesdisclosing a positive HIV status to an intimate partner remains a daunting and a complex undertakingHoweverthose who disclose are more likely to use condoms with uninfected sex partners and mathematical modeling estimates that increased HIV status disclosure to sex partners may reduce transmissions byFurtherdisclosing of one s HIV status is important for accessing support which can lead to improved retention in careantiretroviral adherence and decreased viral loadDuring Phase I of this project we developed an iPad based virtual reality system that features three virtual characterstwo virtual locations and three disclosure scenarios which represent a variety of common disclosure experiences and contexts experienced by YMSMIn Phase II we will further refine and enhance Tough Talks and develop a full feature version to test via a multi siterandomized controlled trialRCT