Improving HIV Care with mHealth Tools: An App to Detect Neurocognitive Impairment

 描述(申请人提供)：神经认知障碍(NCI)是HIV最常见的临床症状之一，影响多达70%的感染者，包括接受抗逆转录病毒治疗(ART)和病毒血症得到很好控制的人。艾滋病毒中的NCI具有重大的医疗、功能和公共卫生后果(例如，遵守抗逆转录病毒治疗的问题)，但在临床环境中往往未被发现。艾滋病毒相关NCI的常规筛查可以加强提供者与患者之间的沟通，以帮助NCI患者更好地管理他们对ART的坚持和其他健康结果，但这样做面临挑战。例如，艾滋病毒诊所的NCI筛查工具大多是纸笔测试，容易出现管理和评分错误，需要训练有素的人员进行管理、评分和翻译，需要额外的设备，不太适合使用电子医疗记录的现代诊所。为了解决这一公共卫生和医疗实践的差距，我们开发了一种mHealth工具，使筛查在现代临床环境中更容易获得和可持续。NeuroScreen是一款简短、易于使用的NCI筛查测试应用程序(APP)，适用于Android移动设备，旨在由广泛的非专家医疗人员进行管理。该应用程序高度自动化(例如，不需要任何记录保存或评分)，具有标准化的说明，确保每次只需最少的培训就能保持一致的管理。NeuroScreen是超便携的(即，可在任何诊所检查室、偏远和农村环境中使用，或在家访期间使用)，并且完全自给自足(即，不需要纸质表格、钢笔、秒表或其他设备)。NeuroScreen的结果可以立即获得，并可以电子方式传输给各种最终用户，如初级保健提供者、艾滋病毒专家和/或电子医疗记录，以及人口水平监测的数据库。这项研究将评估不同专业水平的艾滋病毒护理提供者(例如医生、护士和病例管理人员)对基于平板电脑的NeuroScreen的可用性和接受性，并确定提供者和诊所级别的促进者以及将这一mHealth工具整合到临床实践中的障碍。然后，这项研究将评估NeuroScreen对182名患有NCI(n=91)和没有NCI(n=91)的HIV感染成年人检测轻度NCI的准确性。随着一个易于使用和准确的工具来检测NCI，并且非常适合使用和转向电子医疗系统的诊所，可以实现对损害的早期检测和持续监测，并帮助医疗保健提供者更有效地与患者就他们的治疗和护理进行沟通，做出更好的转介，并提供量身定制的ART依从性干预措施和策略以及艾滋病毒预防服务。此外，NeuroScreen为卫生系统提供了一种可行的方法来收集适合于人群水平的流行病学研究和其他利用大数据的研究的大量神经认知数据。像NeuroScreen这样的mHealth工具可以很容易地进行修改，以用于世界上其他疾病人群和地区，这些疾病人群和地区由于医疗资源非常有限而依赖任务转移。

 DESCRIPTION (provided by applicant): Neurocognitive impairment (NCI) is one of the most common clinical conditions seen in HIV, affecting as many as 70% of infected individuals, including those on antiretroviral therapy (ART) and with well-controlled viremia. The NCI seen in HIV has significant medical, functional, and public health consequences (e.g., problems adhering to ART), but often goes undetected in the clinical setting. Routine screening for HIV-related NCI can enhance provider-patient communication to help patients with NCI better manage their ART adherence and other health outcomes, but doing so faces challenges. For instance, most screening tools for NCI in HIV clinics are paper-and-pencil tests prone to administration and scoring errors that require highly trained personnel to administer, score and interpret, require additional equipment, and are not well-suited for modern clinics utilizing electronic medical records. To address this public health and medical practice gap, we have developed an mHealth tool to make screening more accessible and sustainable in the modern clinical setting. NeuroScreen is a brief, easy-to-use NCI screening test application (app) for Android mobile devices designed to be administered by a wide range of non-expert healthcare personnel. The app is highly automated (e.g., does not require any record keeping or scoring) with standardized instructions ensuring consistent administrations each and every time with minimal training. NeuroScreen is ultra-portable (i.e., usable in any clinic exam room, remote and rural settings, or during home visits) and totally self-contained (i.e., no need for paper forms, pens, stopwatches, or other apparatuses). Results from NeuroScreen are available immediately and can be transmitted electronically to a variety of end-users, such as primary care providers, HIV specialists and/or electronic medical records, as well as to databases for population level monitoring. This study will assess the usability and acceptability of a tablet-based NeuroScreen by HIV care providers of differing expertise levels (e.g., physicians, nurses, and case managers), and identify provider- and clinic-level facilitators and barriers to integrating this mHealth tool into clinical practice. The study will then evaluate NeuroScreen's accuracy to detect mild NCI in 182 HIV-infected adults with NCI (n=91) and without NCI (n=91). With an easy-to-use and accurate tool to detect NCI and well-suited for clinics using and moving towards electronic medical systems, early detection and on-going monitoring of impairment could be realized and help healthcare providers communicate more effectively with patients about their treatment and care, make better referrals, and offer tailored ART adherence interventions and strategies as well as HIV prevention services. Furthermore, NeuroScreen offers health systems a viable method to collect large quantities of neurocognitive data suited to population level epidemiological research and other studies utilizing big data. An mHealth tool, like NeuroScreen, could be easily modified for use in other disease populations and regions of the world that rely on task-shifting due to very limited healthcare resources.