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.

项目摘要 尽管努力实现UNAID 95-95-95的目标，但在抗逆转录病毒疗法（ART）依从性中仍然有明显的定义 和艾滋病毒（PLWH）患者中的病毒抑制。艾滋病毒治疗成功的差距尤其是 在种族和少数族裔人口中，尤其是在美国东北部的拉丁美洲人（美国）中发音（美国） 和加勒比海。 PLWH中HIV疾病和过早死亡的进展已归因于 参与医疗保健和遵守艾滋病毒治疗方案不足。及时获得艺术和随后的访问 持续的艺术依从性对于治疗成功和长期健康结果的关键决定者至关重要（例如， PLWH中的病毒抑制）。为此，我们的团队进行了广泛的形成性工作（CDC：U01PS003715） 种族/族裔少数民族PLWH及其提供商，以识别移动设备的内容，功能，功能和界面 应用程序改善健康结果，包括艺术依从性。基于调查结果，医疗保健研究机构 和质量（AHRQ）为构建该应用程序提供了支持，并将其与智能药盒（CleverCap）集成在一起 实时自我监测他们的药物依从性。这种创新的工具，智慧，取代了当前的方法 使用与电子药盒链接的自我管理移动应用程序进行艺术依从性，目前正在评估 纽约市（NYC）的随机对照试验（RCT）（NCT03205982）。同时，有很大的需求 为了开发和测试西班牙语拉丁裔PLWH的自我管理干预措施，因为它们是 美国最大，最快的少数民族群体，受艾滋病毒的影响不成比例。我们建议 通过翻译和 在文化上对其进行调整并进行多站点RCT来评估其有效性。拟议的项目与AHRQ保持一致 特别重点通知非HS-16-015，并将使用健康信息技术来促进收集和使用 由患者报告的结果，包括药物依从性，生活质量和症状伯恩。该研究将解决 以下具体目的：1。适应并确保WiseApp对西班牙语PLWH的可用性。 2。进行 与跨国样本中通常的护理控制相比，RCT评估WISEAPP的效率和可持续性 3、6和12个月的西班牙语PLWH。 3。确定多层次障碍和促进者 实施WISEAPP。 WISEAPP的混合方法，多方利益相关者流程评估将是 在实施研究的合并框架的指导下进行。拟议的项目建立在我们的基础上 团队强大的初步数据，并利用哥伦比亚大学和克里尼卡·德家族之间的牢固联系 在DR。通过利用拉丁美洲人的强大存在，该项目的意义进一步增强了 纽约市的华盛顿高地社区，DR中的艾滋病毒率高不成比例 纽约市与博士之间的地理流动性。重要的是，我们的研究重点是AHRQ优先人群， 特别是长期生病，市中心，低收入和种族/族裔少数民族。