Dissemination of the WiseApp for Improving Health Outcomes Across Settings

传播 WiseApp 以改善跨环境的健康结果

• 批准号: 10490284
• 负责人: Rebecca Schnall
• 金额: $ 39.41万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10490284
• 关键词: Dissemination; WiseApp; Improving; Health; Outcomes

PROJECT SUMMARY Despite efforts to achieve UNAIDS 95-95-95 targets, marked deficits remain in antiretroviral therapy (ART) adherence and viral suppression among persons living with HIV (PLWH). Gaps in HIV treatment success are particularly pronounced in racial and ethnic minority populations and particularly among Latinos in the Northeast United States (US) and the Caribbean. Progression of HIV disease and premature deaths among PLWH have been attributed foremost to insufficient engagement in medical care and adherence to HIV treatment regimens. Timely access to ART and subsequent sustained ART adherence are central to therapeutic success and critical determinants of long-term health outcomes (e.g., viral suppression) in PLWH. To that end, our team conducted extensive formative work (CDC:U01PS003715) with racial/ethnic minority PLWH and their providers to identify the content, features, functionalities, and interface of a mobile app to improve health outcomes, including ART adherence. Building on the findings, the Agency for Healthcare Research and Quality (AHRQ) provided support to build this app and integrate it with a smart pill box (CleverCap) enabling PLWH to self-monitor their medication adherence in real-time. This innovative tool, the WiseApp, supersedes current approaches to ART adherence using a self-management mobile app linked to an electronic pill box and is currently being evaluated in a randomized controlled trial (RCT) (NCT03205982) in New York City (NYC). At the same time, there is a strong need for the development and testing of self-management interventions for Spanish speaking Latino PLWH since they are the largest and fastest growing ethnic minority group in the US and are disproportionately affected by HIV. We propose to test the transferability of the WiseApp to Latinos in the US and the Dominican Republic (DR) by translating and culturally adapting it and conducting a multi-site RCT to assess its efficacy. The proposed project is aligned with AHRQ Special Emphasis Notice NOT-HS-16-015 and will use health information technology to facilitate the collection and use of patient-reported outcomes including medication adherence, quality of life, and symptom burden. The study will address the following specific aims: 1. Adapt and ensure the usability of the WiseApp for Spanish speaking PLWH. 2. Conduct a RCT to assess the efficacy and sustainability of the WiseApp compared to a usual care control in a transnational sample of Spanish speaking PLWH at 3, 6, and 12 months. 3. Identify multi-level barriers and facilitators to the widespread implementation of the WiseApp. A mixed-methods, multi-stakeholder process evaluation of the WiseApp will be conducted guided by the Consolidated Framework for Implementation Research. The proposed project builds on our team's robust preliminary data and capitalizes on the strong linkage between Columbia University and Clínica de Familia in the DR. This project's significance is further enhanced by capitalizing on the strong presence of Latinos in the Washington Heights neighborhood of NYC, the disproportionately high rates of HIV in the DR, and the patterns of geographic mobility between NYC and the DR. Importantly, our study focuses on AHRQ Priority Populations, specifically chronically ill, inner-city, low-income, and racial/ethnic minority persons.

项目概要 尽管努力实现联合国艾滋病规划署 95-95-95 目标，但抗逆转录病毒治疗 (ART) 依从性仍然存在明显缺陷 以及艾滋病毒感染者（PLWH）的病毒抑制。艾滋病毒治疗成功率方面的差距尤其明显 在少数种族和族裔人口中尤为明显，尤其是在美国东北部的拉丁裔中 和加勒比海。艾滋病毒感染者疾病进展和艾滋病病毒感染者过早死亡的主要原因是 医疗保健参与度和对艾滋病毒治疗方案的依从性不足。及时获得 ART 和后续治疗 持续的 ART 坚持对于治疗成功至关重要，也是长期健康结果的关键决定因素（例如， PLWH 中的病毒抑制）。为此，我们的团队进行了广泛的形成工作 (CDC:U01PS003715) 少数种族/族裔艾滋病患者及其提供商识别移动设备的内容、特性、功能和界面 应用程序可改善健康结果，包括 ART 依从性。根据调查结果，医疗保健研究机构 和质量 (AHRQ) 提供了构建此应用程序的支持，并将其与智能药盒 (CleverCap) 集成，从而支持 PLWH 实时自我监控他们的药物依从性。 WiseApp 这一创新工具取代了当前的方法 使用与电子药盒相连的自我管理移动应用程序来提高 ART 依从性，目前正在评估 纽约市 (NYC) 的一项随机对照试验 (RCT) (NCT03205982)。同时，也有强烈的需求 为讲西班牙语的拉丁裔 PLWH 制定和测试自我管理干预措施，因为他们是 美国最大、增长最快的少数族裔群体，受艾滋病毒影响尤为严重。我们建议 通过翻译和测试 WiseApp 向美国和多米尼加共和国 (DR) 的拉丁美洲人的可转移性 对其进行文化调整并进行多中心随机对照试验以评估其功效。拟议项目符合 AHRQ 特别强调通知 NOT-HS-16-015 并将使用健康信息技术以方便收集和使用 患者报告的结果，包括药物依从性、生活质量和症状负担。该研究将解决 具体目标如下： 1. 调整并确保 WiseApp 对于西班牙语 PLWH 的可用性。 2. 进行 在跨国样本中评估 WiseApp 与常规护理对照的有效性和可持续性的随机对照试验 3、6 和 12 个月时讲西班牙语的感染者的情况。 3. 确定广泛应用的多层次障碍和促进因素 WiseApp 的实施。对 WiseApp 进行混合方法、多利益相关者流程评估 在实施研究综合框架的指导下进行。拟议的项目建立在我们的基础上 团队可靠的初步数据，并利用哥伦比亚大学和 Clínica de Familia 之间的紧密联系 在博士。通过利用拉丁裔在该地区的强大影响力，该项目的重要性进一步增强 纽约市华盛顿高地社区、DR 中不成比例的高艾滋病毒感染率以及感染模式 纽约市和 DR 之间的地理流动性。重要的是，我们的研究重点是 AHRQ 优先人群， 特别是慢性病患者、内城区患者、低收入患者和少数族裔/族裔患者。