A Web-Based Approach to Evaluating HIV-Associated Neurocognitive Disorders

描述（由申请人提供）：hiv相关神经认知障碍（HAND）在联合抗逆转录病毒治疗（ART）时代很常见，是公共卫生资源的重大负担。然而，目前用于筛查和确定HAND日常功能影响的标准实践方法通常是不敏感的、过时的和/或在临床常规使用中非常不切实际的，这可能会导致许多患有综合征的HAND的个体未得到诊断和治疗，从而对健康结果产生不利影响。互联网技术的进步可能提供一个特别密切的、自然的、用户友好的和现代的平台，在这个平台上为HAND开发下一代的日常功能评估。值得注意的是，艾滋病毒感染者的日常功能独立性越来越依赖于万维网的导航，以获取医疗（例如，药房和健康信息）、家庭（例如，购物和银行业务），甚至社会心理（例如，社交网络）资源。因此，下一代神经aids日常功能结果的生态有效性和可行性需要开发基于互联网的特定表现任务，以增强HAND的诊断和治疗。本R21的目的是验证一系列新颖的、创新的日常功能任务（即，家庭购物，财务管理），这些任务使用现实的、最先进的基于网络的方法来评估HAND。一项发展目标将设计和试点一项自然的在线卫生知识搜索措施，以及在移动平台上进行药房补充和沟通任务，从而加强了这些评估的可移植性和与健康的相关性。我们建议从加州大学圣地亚哥分校HIV神经行为研究项目（HNRP）中招募100名HIV感染者（HAND患病率为50%）和50名血清阴性受试者，从而免费利用这些受试者的综合临床特征。假设艾滋病毒感染将与这些基于网络的任务中较差的“现实世界”功能有关，这将与健康素养（例如，知识），神经认知（例如，执行功能障碍）和日常功能（例如，药物管理）的良好验证措施相关。与目前的实践标准方法相比，预计基于网络的评估将改进HAND的诊断分类。因此，这一R21应用程序提出了重要的第一步，以确定是否可以使用互联网技术更准确、更有效地确定艾滋病毒感染的“现实世界”影响。

DESCRIPTION (provided by applicant): HIV-associated neurocognitive disorders (HAND) are common in the era of combined antiretroviral therapy (ART) and are a significant burden on public health resources. Yet current standard-of-practice methods for screening and ascertaining the everyday functioning impact of HAND are generally insensitive, outdated, and/or highly impractical for routine use in clinic, which may adversely affect health outcomes by leaving many individuals with syndromic HAND undiagnosed and untreated. Advances in Internet technology may provide an especially germane, naturalistic, user-friendly, and contemporary platform upon which to develop the next generation of everyday functioning assessments for HAND. Of note, the everyday functioning independence of individuals living with HIV infection is increasingly dependent on navigation of the World Wide Web to engage medical (e.g., pharmacy and health information), household (e.g., shopping and banking), and even psychosocial (e.g., social networking) resources. As such, the ecological validity and viability of the next generation of everyday functioning outcomes in neuroAIDS necessitates the development of Internet-specific performance- based tasks in order to enhance diagnosis and treatment of HAND. The aim of this R21 is to validate a series of novel, innovative tasks of everyday functioning (i.e., household shopping, financial management) that use a realistic, state-of-the-art web-based approach to evaluating HAND. The portability and health-relevance of these assessments are enhanced by a developmental aim that will engineer and pilot a naturalistic online health literacy search measure and a pharmacy refill and communication task on a mobile platform. We propose to recruit 100 persons with HIV infection (with a 50% prevalence of HAND) and 50 seronegative subjects from ongoing studies within the UCSD HIV Neurobehavioral Research Program (HNRP), thereby leveraging the comprehensive clinical characterization of these subjects at no cost to this grant. It is hypothesized that HIV infection will be associated with worse "real world" functioning on these web-based tasks, which will correlate with well-validated measures of health literacy (e.g., knowledge), neurocognition (e.g., executive dysfunction), and everyday functioning (e.g., medication management). It is expected that the web-based assessments will improve the diagnostic classification of HAND as compared to current standard- of-practice approaches. Accordingly, this R21 application proposes an important first step in determining whether Internet technology can be used to more accurately and effectively determine the "real world" impact of HIV infection.