Improving Linkage to HIV Care Through Mobile Phone Apps: Randomized Controlled Trial.
Improving Linkage to HIV Care Through Mobile Phone Apps: Randomized Controlled Trial.
复制标题
通过手机应用改善与艾滋病毒护理的联系：随机对照试验。
DOI：
10.2196/mhealth.8376
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发表时间：
2018-07-17
影响因子：
5
通讯作者：
Fraser-Hurt N
中科院分区：
文献类型：
--
作者：
Venter W;Coleman J;Chan VL;Shubber Z;Phatsoane M;Gorgens M;Stewart-Isherwood L;Carmona S;Fraser-Hurt N
在艾滋病毒治疗方案中，“级联护理”中的差距，即患者在诊断、实验室评估、治疗开始和保留艾滋病毒护理之间的损失，是一个众所周知的挑战。越来越多的人使用支持互联网的移动的手机，这使得人们对使用该技术来改善患者与医疗保健的互动产生了兴趣。本试验的目的是：（1）评估支持移动的手机应用程序是否可以为HIV患者提供实验室检测结果，（2）更好地了解此类干预措施的实施情况，以及（3）确定应用程序在改善诊断后与HIV护理联系方面的有效性。我们通过在约翰内斯堡的几家初级卫生保健机构进行的随机对照试验开发和测试了一款应用程序。新诊断的HIV阳性患者被筛选、招募并随机分配到试验中，因为他们提供了用于初始CD 4分期的血液样本。试用资格包括拥有与应用程序兼容的手机和访问互联网。对试验参与者进行了至少8个月的随访，以确定与HIV相关实验室检测结果所指示的HIV护理的联系。试验结果正在准备出版，但在这里，我们描述了实施提供的重要操作和技术经验教训。由于Android的功能和通信特性，Android被认为是最适合该应用程序的操作系统。Android在南非所有智能手机操作系统中也占有最大的市场份额。该应用程序成功开发，实验室结果发送到个人智能手机。然而，考虑到试验要求和应用程序本身，只有10%的筛查HIV患者成功入组。我们报告的问题，如病人的资格，应用程序测试在一个动态的电话市场，软件安装和兼容性，安全识别的病人，实验室结果的链接到缺乏唯一标识符的病人，并提出教训和潜在的解决方案。这项试验的实施挑战和经验教训可能有助于未来类似的mHealth干预措施，以避免一些陷阱。如果确保软件开发人员和执行小组拥有足够的专门知识并了解方案需要，并在目标群体中进行充分和迅速的试点，就可以更好地进行审判人员的征聘。然而，大多数筛选的患者对这项研究感兴趣，并且该应用程序成功安装在具有合适智能手机的患者中，这表明这可能是未来让患者参与其医疗保健数据的一种方式。ClinicalTrials.gov NCT 02756949; https://clinicaltrials.gov/ct2/show/NCT02756949（由WebCite存档，网址为http：//www.webcitation.org/6z1GTJCNW）
In HIV treatment program, gaps in the “cascade of care” where patients are lost between diagnosis, laboratory evaluation, treatment initiation, and retention in HIV care, is a well-described challenge. Growing access to internet-enabled mobile phones has led to an interest in using the technology to improve patient engagement with health care. The objectives of this trial were: (1) to assess whether a mobile phone–enabled app could provide HIV patients with laboratory test results, (2) to better understand the implementation of such an intervention, and (3) to determine app effectiveness in improving linkage to HIV care after diagnosis. We developed and tested an app through a randomized controlled trial carried out in several primary health care facilities in Johannesburg. Newly diagnosed HIV-positive patients were screened, recruited, and randomized into the trial as they were giving a blood sample for initial CD4 staging. Trial eligibility included ownership of a phone compatible with the app and access to the internet. Trial participants were followed for a minimum of eight months to determine linkage to HIV care indicated by an HIV-related laboratory test result. The trial outcome results are being prepared for publication, but here we describe the significant operational and technological lessons provided by the implementation. Android was identified as the most suitable operating system for the app, due to Android functionality and communication characteristics. Android also had the most significant market share of all smartphone operating systems in South Africa. The app was successfully developed with laboratory results sent to personal smartphones. However, given the trial requirements and the app itself, only 10% of screened HIV patients successfully enrolled. We report on issues such as patient eligibility, app testing in a dynamic phone market, software installation and compatibility, safe identification of patients, linkage of laboratory results to patients lacking unique identifiers, and present lessons and potential solutions. The implementation challenges and lessons of this trial may assist future similar mHealth interventions to avoid some of the pitfalls. Ensuring sufficient expertise and understanding of the programmatic needs by the software developer, as well as in the implementation team, with adequate and rapid piloting within the target groups, could have led to better trial recruitment. However, the majority of screened patients were interested in the study, and the app was installed successfully in patients with suitable smartphones, suggesting that this may be a way to engage patients with their health care data in future. ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW)