Screen Smart: Using Digital Health to Improve HIV Screening and Prevention for Adolescents in the Emergency Department

智能屏幕：利用数字健康改善急诊科青少年的艾滋病毒筛查和预防

• 批准号: 10711679
• 负责人: Nadia L Dowshen
• 金额: $ 87.19万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-13 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10711679
• 关键词: AIDS prevention; Accident and Emergency department; Accounting; Acute; Address; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Affect; Applied Research; Appointment; Awareness; Behavior; Caring; Centers for Disease Control and Prevention (U.S.); Chlamydia; Clinical; Collaborations; Collection; Computers; Country; Data; Data Reporting; Detection; Development; Diagnosis; Education; Effectiveness; Electronic Health Record; Electronics; Eligibility Determination; Emergency Care; Emergency department visit; Epidemic; Goals; Gonorrhea; HIV; HIV-infected adolescents; HIV/AIDS; Health; Health Technology; Healthcare; Home; Hour; Human immunodeficiency virus test; Infection; Interruption; Intervention; Link; Literature; Location; Logistics; Measures; Medical; Methods; Patient Outcomes Assessments; Patients; Pediatric Hospitals; Persons; Policies; Population; Prevention; Prevention program; Prevention strategy; Preventive care; Preventive healthcare; Primary Care; Process; Provider; Public Health; Recommendation; Research; Risk; Series; Services; Sexual Health; Source; Tablets; Testing; Text Messaging; Time; United States; Viral; Visit; Work; Youth; age group; candidate identification; clinical decision support; clinical practice; computed tomography screening; computerized; cost effective; design; digital health; evidence base; follow-up; health care settings; high risk; high risk sexual behavior; implementation strategy; improved; innovation; insight; interest; mHealth; novel; pediatric emergency; pragmatic trial; pre-exposure prophylaxis; preference; prevent; primary care services; primary care setting; provider adherence; response; screening; screening program; seroconversion; stem; telehealth; treatment adherence; uptake

Project Summary: Adolescents and young adults (AYA) are disproportionately affected by HIV in the US. Despite adolescents accounting for over 20% of new infections, this age group is the least likely to be tested for HIV, linked to care, and achieve viral suppression when compared to their adult counterparts. Further, AYA also have low rates of HIV awareness and initiation of HIV Pre-Exposure Prophylaxis (PrEP). Therefore, there is an urgent need to expand HIV screening and prevention strategies to nontraditional healthcare settings such as emergency departments (ED) to reach those adolescents who would otherwise not receive preventive healthcare. The goal of this application is to leverage our recent insights obtained from a multi-center, ED-based, adolescent gonorrhea and chlamydia screening study and apply them across a national pediatric ED research network by (1) adapting, refining, and testing this process to increase universally offered, opt-out HIV screening among adolescents in the pediatric ED and (2) link at-risk adolescents to PrEP services and preventive care. This will be accomplished through a network of children’s hospital EDs with a track record of robust research collaboration (Pediatric Emergency Care Applied Research Network or PECARN). This research will contribute to the evidence base for creating clinically effective and sustainable HIV screening programs that can be successfully implemented into the clinical workflow of the ED. It will also improve identification and linkage to PrEP care for at risk adolescents using mHealth strategies by first identifying AYA who are PrEP candidates based on their responses to a computerized sexual health screen (cSHS) and subsequently (1) providing clinical decision support to providers via the electronic health record and (2) direct text messaging from the cSHS to PrEP candidates providing educational content and connecting youth to a PrEP navigator. This intervention will rely on an innovative approach that electronically integrates patient-reported data to guide clinical decision support. This work is significant because it has the potential to shift current ED clinical practice paradigms from only acute health encounters to participation in the broader management of public health and prevention, and it will fill gaps in the literature needed to provide evidence for the best method of HIV screening in a pediatric ED setting. Using a previously developed tablet-based, broad scale GC/CT screening process, we will adapt, refine, and test this process with the aim of increasing universally offered, opt-out HIV screening in the pediatric ED through electronic integration of patient reported data for provision of clinical decision support for HIV screening and identification of PrEP candidacy, and then use mHealth to link patients to PrEP services. This research is novel in that it shifts the usual clinical practice paradigm of HIV screening and prevention in the pediatric ED from a scattered approach to a consistent and sustainable approach that is critical to addressing the HIV epidemic among adolescents.

项目概要： 在美国，青少年和年轻人（AYA）受到艾滋病毒的影响不成比例。尽管青少年 占新感染人数的20%以上，这一年龄组最不可能接受艾滋病毒检测，与护理有关， 并达到抑制病毒的效果。此外，AYA也具有低的 艾滋病毒意识和艾滋病毒暴露前预防（PrEP）的启动。因此，迫切需要 将艾滋病毒筛查和预防战略扩大到非传统医疗环境， 此外，还设立了艾德部门，以帮助那些原本无法获得预防性保健的青少年。目标 这项应用的目的是利用我们最近从一个多中心的，以ED为基础的，青少年的 淋病和衣原体筛查研究，并将其应用于全国儿科艾德研究网络（1） 调整、完善和测试这一过程，以增加普遍提供的、选择退出的艾滋病毒筛查， 儿童艾德中的青少年;（2）将高危青少年与PrEP服务和预防保健联系起来。这将是 通过儿童医院急诊科网络完成，具有强大的研究合作记录 （Pediatric Emergency Care Applied Research Network或PECARN）这项研究将有助于 建立临床有效和可持续的艾滋病毒筛查计划的证据基础， 实施到ED的临床工作流程中。它还将改善识别和与PrEP护理的联系， 使用移动健康策略的风险青少年，首先确定AYA谁是基于他们的PrEP候选人， 对计算机化性健康筛查（cSHS）的反应，随后（1）提供临床决策 通过电子健康记录向提供者提供支持，以及（2）从cSHS向PrEP直接发送短信 候选人提供教育内容，并将青年与PrEP导航员联系起来。这种干预将依赖于 一种创新的方法，以电子方式整合患者报告的数据，以指导临床决策支持。这 这项工作是重要的，因为它有可能改变目前的艾德临床实践范式， 从参加更广泛的公共卫生和预防管理， 在文献中需要提供证据的最佳方法艾滋病毒筛查在儿科艾德设置。使用 以前开发的基于平板电脑的大规模GC/CT筛查过程，我们将对其进行调整，完善和测试 旨在通过以下方式增加儿科艾德普遍提供的、选择退出的艾滋病毒筛查 电子整合患者报告的数据，为HIV筛查提供临床决策支持， 识别PrEP候选人，然后使用mHealth将患者与PrEP服务联系起来。这项研究是新颖的， 它改变了儿科艾德艾滋病毒筛查和预防的常规临床实践范式， 从分散的方法转向对应对艾滋病毒流行至关重要的一致和可持续的方法 在青少年中。