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

项目总结： 在美国，青少年和青壮年(Aya)受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，这一年龄段最不可能接受艾滋病毒检测，与护理有关， 与成年同龄人相比，实现了病毒抑制。此外，阿亚也有较低的 艾滋病毒认识和艾滋病毒暴露前预防的启动(PrEP)。因此，迫切需要 将艾滋病毒筛查和预防策略扩展到非传统医疗保健环境，如紧急情况 各部门(ED)帮助那些本来不会得到预防性保健的青少年。目标是 此应用程序的关键是利用我们从多中心、以ED为基础的青少年那里获得的最新见解 淋病和衣原体筛查研究，并在全国儿科急诊科研究网络中应用(1) 调整、改进和测试这一过程，以增加普遍提供的、选择退出的艾滋病毒筛查 儿科急诊室的青少年和(2)将高危青少年与PrEP服务和预防护理联系起来。这将是 通过儿童医院急诊室网络完成，并有良好的研究合作记录 (儿科急救应用研究网络或PECARN)。这项研究将有助于 创建临床有效和可持续的艾滋病毒筛查计划的证据基础 落实到急诊科的临床工作流程中。它还将改善识别和与初级保健计划护理的联系 使用mHealth策略的青少年的风险，首先根据他们的情况确定谁是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到PrEP的直接文本消息传递 候选人提供教育内容，并将年轻人与PrEP导航器联系起来。这一干预将依赖于 一种电子集成患者报告数据以指导临床决策支持的创新方法。这 这项工作意义重大，因为它有可能将当前的急诊临床实践范式从仅限于急性 卫生遇到参与更广泛的公共卫生和预防管理，它将填补空白 在文献中需要提供证据，证明在儿科急诊室中进行艾滋病毒筛查的最佳方法。vbl.使用 以前开发的基于片剂的大规模GC/CT筛查过程，我们将对其进行调整、改进和测试 旨在通过以下途径在儿科急诊室增加普遍提供的、选择不接受的艾滋病毒筛查 患者报告数据的电子集成，以提供艾滋病毒筛查和临床决策支持 确定PrEP候选资格，然后使用mHealth将患者与PrEP服务联系起来。这项研究在以下方面是新颖的 它改变了儿科急诊室通常的艾滋病毒筛查和预防的临床实践范式 采取分散的办法，采取一致和可持续的办法，这对解决艾滋病毒流行至关重要 在青少年中。

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.