A Mobile App for LMIC Lay Health Workers to Screen for Neurocognitive Impairment

描述(申请人提供)：南非有610万艾滋病毒感染者，是世界上艾滋病毒携带者人数最多的LMIC。为了解决由此造成的卫生保健人员短缺问题，南非采用了一种任务转移战略，由非专业卫生工作者提供艾滋病毒护理的组成部分。神经认知障碍(NCI)是HIV感染最常见的后遗症和共病之一，具有重大的医疗、功能和公共卫生后果。NCI影响了超过一半的艾滋病毒感染者，但在临床环境中往往没有被发现。尽管与其他慢性疾病一样，艾滋病毒非传染性感染常规筛查可以加强提供者与患者之间的沟通，以促进服药依从性和积极的健康结果，但它面临着许多挑战，包括需要特殊设备和训练有素的人员来管理、评分和解释筛查测试。移动技术可以通过促进艾滋病毒和其他慢性病中NCI的常规筛查，为这一关键的公共卫生和医疗保健挑战提供解决方案。为此，我们开发了NeuroScreen，这是一款针对Android设备的简短、易于使用的NCI筛查测试应用程序，旨在供临床环境中的各种非专家医护人员使用。这款应用程序是标准化的，高度自动化，只需要最少的培训就可以管理，而且不需要保存记录或评分。它可以用于诊所检查室、偏远的农村环境和/或家访，不需要纸质表格、秒表或其他设备。NeuroScreen的结果可以立即获得，并可以通过电子方式传输给各种“最终用户”，例如初级保健提供者、艾滋病毒或其他专家，和/或电子医疗记录。拟议的研究将(1)使NeuroScreen适用于讲科萨语的南非非专业顾问；(2)评估顾问管理的APP在100名HIV+成年人中检测NCI的敏感性和特异性，以及它的可用性和 可接受性；以及(3)探索NeuroScreen结果与医疗健康结果之间的联系--即ART治疗失败的客观行为和生物标记物。这些数据将成为未来在LMIC环境中使用的这一mHealth工具的实施和扩大的更大规模研究的基础。NeuroScreen可以很容易地进行修改，用于其他疾病和由于医疗资源有限而依赖任务转移的LMIC。该项目将通过几种方式在南非建立研究能力。首先，我们在制定这项建议方面的国内合作者和合作伙伴将继续在基于这项研究的未来研究中与我们合作。其次，这项研究将培养南非软件开发人员将他们的专业知识应用于公共卫生和临床研究的能力。第三，我们将在卫生署诊所和开普敦大学提供有关NCI和mHealth工具的在职培训，并向UCT的医学和研究学员传播研究结果和经验教训，并举办研讨会，讨论开发和实施mHealth研究和工具。

DESCRIPTION (provided by applicant): With 6.1 million HIV-infected individuals, South Africa is an LMIC with the world's largest population of people living with HIV. To address the resulting shortages in healthcare personnel, South Africa uses a task-shifting strategy in which lay health workers provide components of HIV care. Neurocognitive impairment (NCI) is one of the most common sequelae and comorbid conditions of HIV infection and has significant medical, functional, and public health consequences. NCI affects over half of HIV-infected individuals, yet often goes undetected in the clinical setting. Although - as in other chronic diseases - routine screening for NCI in HIV can enhance provider-patient communication to promote medication adherence and positive health outcomes, it faces numerous challenges, including the need for special equipment and highly trained personnel to administer, score and interpret screening tests. Mobile technology can offer a solution to this critical public health and medical care challenge by facilitating routine screening for NCI in HIV and other chronic illnesses. To this end, we developed NeuroScreen, a brief, easy-to-use NCI screening test app for Android devices, designed to be administered by a wide range of non- expert healthcare personnel in clinical settings. The app is standardized and highly automated, requires minimal training to administer, and does not require record-keeping or scoring. It can be used in clinic exam rooms, remote rural settings, and/or home visits and requires no paper forms, stopwatches, or other equipment. NeuroScreen results are available immediately and can be transmitted electronically to a variety of "end-users," such as primary care providers, HIV or other specialists, and/or electronic medical records. The proposed study will (1) adapt NeuroScreen for administration by South African, Xhosa-speaking lay counselors; (2) evaluate the counselor-administered app's sensitivity and specificity to detect NCI among 100 HIV+ adults, as well as its usability and acceptability; and (3) explore the association between NeuroScreen results and medical health outcomes - i.e., objective behavioral and biological markers of ART treatment failure. These data will be the basis for future larger-scale research on implementation and scale-up of this mHealth tool for use in LMIC settings. NeuroScreen could be easily modified for use in other diseases and LMICs that rely on task-shifting due to limited healthcare resources. This project will build research capacity in South Africa in several ways. First, our in-country collaborators and partners in developing this proposal will continue to work with us in future research based on this study. Second, this study will build the South African software developers' capacity to apply their expertise to public health and clinical research. Third, we will offer in-service trainings on NCI and mHealth tools at DOH clinics and the University of Cape Town, as well as disseminate findings and lessons learned and conduct seminars on developing and implementing mHealth research studies and tools to UCT medical and research trainees.