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的日常功能影响的标准实践方法对于临床中的常规使用来说通常是不敏感的、过时的和/或非常不切实际的，这可能通过使许多患有综合征性HAND的个体未被诊断和治疗而对健康结果产生不利影响。互联网技术的进步可以提供一个特别密切的，自然的，用户友好的，和当代的平台上，开发下一代的日常功能评估手。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，以参与医疗（例如，药房和健康信息），家庭（例如，购物和银行业务），甚至心理社会（例如，社交网络）资源。因此，neuroAIDS中下一代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性能的任务，以加强HAND的诊断和治疗。这个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），使用现实的，国家的最先进的基于网络的方法来评估手。这些评估的可移植性和健康相关性通过一个发展目标得到加强，该目标将设计和试行一项自然主义的在线健康扫盲搜索措施以及一项在移动的平台上的药房续药和通信任务。我们建议从UCSD HIV神经行为研究计划（HNRP）中正在进行的研究中招募100名HIV感染者（HAND患病率为50%）和50名血清阴性受试者，从而利用这些受试者的全面临床特征，无需为此拨款支付任何费用。据推测，艾滋病毒感染将与这些基于网络的任务上更差的“真实的世界”功能相关，这将与经过充分验证的健康素养措施相关（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）。与目前的标准实践方法相比，预计基于网络的评估将改善HAND的诊断分类。因此，这一R21应用程序提出了重要的第一步，以确定互联网技术是否可以用来更准确和有效地确定艾滋病毒感染对“真实的世界”的影响。

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methods for screening and ascertaining the everyday functioning impact of HAND are generally insensitive, outdated, and/or highly impractical for routine use in clinic, which may adversely affect health outcomes by leaving many individuals with syndromic HAND undiagnosed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.