MICA:Development of new paradigm in differentiated care for HIV patients; Community pharmacy drug refill using the ARTAccess Mobile phone application.

我们在向世界各地的艾滋病毒携带者提供救命药物方面取得了很大进展。然而，全球仍有约1500万人需要治疗。这种治疗对于防止艾滋病毒携带者患病和死亡至关重要，但它也有助于防止新的感染发生。由于目前还没有针对艾滋病毒的疫苗，也没有治愈方法，这是防止感染传播的一种非常重要的形式。然而，在乌干达等许多地方，治疗艾滋病毒患者的费用给卫生服务带来了巨大的压力，随着更多的患者需要治疗，这一数字将会增加。因此，我们需要找到不同的方法来提供艾滋病毒治疗，使卫生服务能够应对。这可能包括减少患者每次去诊所都需要看医生或护士，从而减轻工作人员的负担，减少涉及的文书工作，使患者更容易在离家较近的地方获得药物，这样他们就不会损失工作时间，等等。许多人现在已经服药多年，情况非常好。目前，他们仍然需要经常(每1-3个月)到当地的诊所取药，这给他们和他们的临床增加了负担。我们建议使用移动电话技术来看看我们是否可以帮助减轻这一负担。在撒哈拉以南的非洲，移动电话很便宜，而且随处可见，很多人都在使用它们。事实上，许多人用它们来汇款和做生意，而不需要银行。我们将使用手机或平板电脑将患者的记录和他们最近的血液测试与社区药店联系起来，这样患者就可以从多个地点获得药物，而不仅仅是他们的诊所。由于这种方法是新的，我们需要看看这项技术是如何工作的，看看患者、医生和护士、药房工作人员和政府对这一系统的看法，以及它对向患者提供服务的影响。我们还将计划进行一项规模更大的研究，将这些技术与其他基于手机的工具联系起来，例如每天提醒服用药物，看看我们如何将整个地理区域联系起来，并简化为艾滋病毒携带者提供的服务。如果这种方法奏效，它可能会被用于数十万人的艾滋病毒治疗，未来可能会被用于乌干达和撒哈拉以南非洲其他地方的高血压或糖尿病等其他疾病。

We have made great progress in getting life saving medication to people living with HIV all over the world. However, there are still around 15 million people worldwide who need treatment. This treatment is essential to stop people living with HIV from getting sick and dying, but it also helps to prevent new infections happening. As there are no vaccines for HIV at the moment and no cure, this is a very important form of preventing the spread of the infection. However, in many setting such as Uganda the cost of treating patients with HIV puts a great strain on the health services, and as more patients need treatment this will increase. Therefore, we need to find different ways of providing HIV treatment which will enable the health services to cope. This could include reducing the need for patients to see a doctor or nurse every time they go to clinic and so reduce the burden on staff, to reduce the paperwork involved, to make it easier for the patients to access their medication near to their homes, so that they do not lose working hours, and many more. Lots of people have now been on medication for a number of years and are doing very well. At the moment they still need to come frequently (every 1-3 months) to their local clinic to pick up medication which adds burden to both them and their clinic.We propose to use mobile phone technology to see if we can help to reduce this burden. Mobile phones are cheap and widely available in sub-Saharan Africa and very many people use them. In fact, many people use them to send money and do business, without the need for banks. We will use a mobile phone or tablet to link the patients records and their recent blood tests to community pharmacies, so that the patients can get their drugs from multiple sites, not just their clinic. As this approach is new we will need to see how the technology works, see what the patients, doctors and nurses, pharmacy staff and the government think about this system and to see what effect it is having on the delivery of services to the patients. We will also plan for a much larger research study which will link these technologies with other mobile phone based tools, such as daily reminders to take pills, and see how we can link up a whole geographical area and streamline the services for people living with HIV. If this works, it may be used for very many hundreds of thousands of people on HIV treatment, and in future may be used for other conditions such as high blood pressure or diabetes in Uganda and elsewhere in sub-Saharan Africa.