An mHealth implementation strategy to address the syndemic of mental illness, hypertension, and HIV in Uganda

解决乌干达精神疾病、高血压和艾滋病毒综合症的移动医疗实施战略

• 批准号: 10752992
• 负责人: Noeline Nakasujja
• 金额: $ 19.33万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-12 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10752992
• 关键词: Acquired Immunodeficiency Syndrome; Acute; Address; Africa South of the Sahara; Algorithms; Anxiety; Anxiety Disorders; Attention; Biological; Biosocial; Blood Pressure; Cardiovascular Diseases; Caregivers; Caring; Cellular Phone; Chronic; Clinic; Clinical; Clinical Trials; Collaborations; Complex; Data; Detection; Diagnosis; Disease; Dose; Economics; Effectiveness; Enrollment; Environment; Epidemic; Event; Evidence based intervention; Face; Funding; General Population; Goals; Government; Government Officials; HIV; Health Personnel; Health Priorities; Health Services Accessibility; Heart failure; Hybrids; Hypertension; Individual; Infrastructure; Intervention; Interview; Life; Link; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Mobile Health Application; National Institute of Mental Health; Outcome; Participant; Patients; Penetration; Persons; Phase; Poverty; Prevalence; Privatization; Process; Qualitative Methods; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Self Care; Severities; Shock; Site; Social Interaction; Stigmatization; Telephone; Testing; Text; Uganda; United States National Institutes of Health; Viral Load result; alcohol use disorder; arm; comorbidity; dashboard; digital platform; effectiveness evaluation; evidence base; human centered design; implementation measures; implementation science; implementation strategy; implementation study; implementation trial; improved; innovation; instrument; low and middle-income countries; mHealth; medication compliance; multidisciplinary; novel; patient engagement; pilot trial; primary outcome; programs; reduce symptoms; screening; secondary outcome; service delivery; social factors; social stigma; standard of care; syndemic; tailored messaging

There are 38 million people living with HIV (PLWH) worldwide, 68% of whom live in sub-Saharan Africa. With the transition of HIV from an acute illness to a chronic condition, co-morbid non-communicable diseases (NCDs) such as depression and anxiety disorder, alcohol use disorder (AUD), and hypertension (HTN) have become epidemic among PLWH. Despite evidence-based interventions to promote integration of these HIV comorbidities into HIV service delivery, integration efforts face challenges. First, integration commonly fails to recognize the syndemic relationships between these conditions and the deleterious effect of social factors such as poverty, stigma, and lack of access to care that worsen their outcomes, especially in low- and middle-income countries. Second, integration commonly imposes additional clinical tasks upon overburdened healthcare workers (HCW) operating in busy clinical environments without private space needed to attend to these additional conditions that are often stigmatized. A syndemic approach, which explicitly integrates the biological and social interactions that cause these conditions to cluster, has been proposed as a means of addressing the complex needs of PLWH. Mobile health (mHealth), an evidence-based strategy that leverages the widespread penetration of mobile phones to relieve HCW of burdensome tasks while enabling their systematic, consistent implementation, has been proposed as a solution to address HIV-related syndemics, but this approach has not been tested. Our exemplary multidisciplinary team has a strong track record of collaboration. In the current proposal, which leverages the infrastructure of an ongoing implementation study of HIV/HTN integration in Uganda, we will pursue these Specific Aims: Aim 1) Adapt Medly Uganda for detection, linkage to care, and ongoing support of depression, anxiety disorder, and AUD among Ugandans with HIV and HTN using a syndemic approach. Through human-centered design (HCD), we will engage patients, caregivers, and professional/lay HCW to guide iterative adaptation of Medly Uganda with explicit attention to common biosocial drivers. The adapted application will integrate widely used (1) screening instruments along with validated measures of significant life events, economic shocks, and stigma, (2) algorithm-driven messaging and alerts, and (3) linkage to HCW for support and treatment. We will also develop and operationalize a novel syndemic care cascade (R21 phase); Aim 2) Assess the effectiveness of the Syndemic-Adapted Medly Uganda (SAMU) to improve mental health care cascade metrics by conducting a single-arm trial using real-world historical data (R33 phase); Aim 3) Evaluate the factors impacting sustained engagement in the adapted Medly Uganda using mixed methods (R33 phase). Throughout the study period, we will focus on strengthening our Uganda-based team's mHealth research capacity and furthering our partnerships with government officials to ensure that SAMU can be locally maintained and sustained. The proposed study addresses a high priority topic for use of AIDS-designated funds at NIH and aligns with multiple National Institute of Mental Health priorities as described in PAR-21-303.

全球有3800万艾滋病毒携带者(PLWH)，其中68%生活在撒哈拉以南非洲。使用 艾滋病毒从急性疾病转变为慢性疾病，并伴有非传染性疾病(NCDs) 如抑郁症和焦虑症、酒精使用障碍(AUD)和高血压(HTN)已经成为 在PLWH中流行。尽管采取循证干预措施来促进这些艾滋病毒共病的融合 在艾滋病毒服务提供方面，一体化努力面临挑战。首先，集成通常无法识别 这些条件与贫困等社会因素的有害影响之间的共同关系， 特别是在低收入和中等收入国家，耻辱和缺乏获得护理的机会使他们的结果恶化。 其次，整合通常会给不堪重负的医护人员(HCW)带来额外的临床任务 在繁忙的临床环境中操作，不需要私人空间来处理这些额外的情况 常常被污蔑。一种共同的方法，它明确地将生物和社会互动 导致这些情况聚集，已经被提出作为解决PLWH复杂需求的一种手段。 移动健康(MHealth)，这是一种基于证据的战略，利用了移动设备的广泛渗透 电话，以减轻HCW繁重的任务，同时实现其系统的，一致的实施， 已经提出作为解决艾滋病毒相关综合症的一种解决方案，但这种方法尚未经过测试。我们的 模范的多学科团队有着良好的协作记录。在目前的提案中， 利用正在进行的乌干达HIV/HTN整合实施研究的基础设施，我们将 追求这些具体目标：目标1)使Medly乌干达适应检测、与护理的联系和持续支持 对感染HIV和HTN的乌干达人中的抑郁、焦虑症和AUD采用共同的方法进行研究。 通过以人为中心的设计(HCD)，我们将吸引患者、护理人员和专业/非专业人员来指导 乌干达Medly的迭代适应，明确关注共同的生物社会驱动因素。改编后的应用程序 将整合广泛使用的(1)筛查工具以及对重大生活事件的有效测量， 经济冲击和耻辱，(2)算法驱动的消息和警报，以及(3)链接到HCW以获得支持 和治疗。我们还将开发和实施一种新的同步护理级联(R21阶段)；目标2) 评估符合共同标准的乌干达医学(SAMU)改善精神卫生保健的有效性 通过使用真实世界历史数据(R33阶段)进行单臂试验的级联指标；目标3)评估 影响在适应后的乌干达使用混合方法的持续参与的因素(R33阶段)。 在整个研究期间，我们将重点加强我们在乌干达的团队的移动健康研究 能力，并进一步加强我们与政府官员的伙伴关系，以确保能够在当地维持Samu 而且持续有效。拟议的研究解决了NIH和NIH使用艾滋病指定资金的高度优先主题 与PAR-21-303中描述的多个国家精神卫生研究所的优先事项保持一致。