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

描述(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手的日常功能影响的实践标准方法通常不敏感、过时和/或在临床上非常不切实际，这可能会使许多患有综合征性手的人得不到诊断和治疗，从而对健康结局产生不利影响。互联网技术的进步可能会提供一个特别贴切、自然、用户友好和当代的平台，在此平台上开发下一代手的日常功能评估。值得注意的是，艾滋病毒感染者的日常活动独立性越来越依赖于万维网的导航，以利用医疗(例如，药房和健康信息)、家庭(例如，购物和银行)，甚至心理社会(例如，社交网络)资源。因此，神经艾滋病的下一代日常功能结果的生态有效性和可行性要求开发基于互联网的特定绩效任务，以加强手部的诊断和治疗。这款R21的目的是验证一系列新颖的、创新的日常运作任务(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。这些评估的便携性和与健康的相关性通过一个发展目标得到加强，该目标将设计和试点一项自然主义的在线健康素养搜索措施，以及一项在移动平台上的药房补充和沟通任务。我们建议从加州大学圣迭戈分校艾滋病毒神经行为研究计划(HNRP)正在进行的研究中招募100名艾滋病毒感染者(HAND患病率为50%)和50名血清阴性受试者，从而利用这些受试者的全面临床特征，而无需支付这笔赠款。据推测，艾滋病毒感染将与在这些基于网络的任务中发挥更差的“现实世界”功能有关，这将与健康素养(例如知识)、神经认知(例如执行障碍)和日常功能(例如药物管理)的良好验证措施相关联。预计与目前的做法标准方法相比，基于网络的评估将改进手部的诊断分类。因此，这一R21应用程序提出了重要的第一步，以确定是否可以利用互联网技术更准确和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methods for screening and ascertaining the everyday functioning impact of HAND are generally insensitive, outdated, and/or highly impractical for routine use in clinic, which may adversely affect health outcomes by leaving many individuals with syndromic HAND undiagnosed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.