MICA:Development of new paradigm in differentiated care for HIV patients; Community pharmacy drug refill using the ARTAccess Mobile phone application.

我们在向世界各地的艾滋病毒感染者提供挽救生命的药物方面取得了巨大进展。然而，全世界仍有大约1500万人需要治疗。这种治疗对于防止艾滋病毒感染者生病和死亡至关重要，但它也有助于防止新感染的发生。由于目前没有针对艾滋病毒的疫苗，也没有治愈方法，这是防止感染传播的一种非常重要的形式。然而，在乌干达等许多环境中，治疗艾滋病毒患者的费用给卫生服务带来了巨大压力，而且随着需要治疗的患者越来越多，这一负担将会增加。因此，我们需要找到提供艾滋病毒治疗的不同方法，使保健服务能够应付。这可能包括减少病人每次去诊所看医生或护士的需要，从而减轻工作人员的负担，减少所涉及的文书工作，使病人更容易在离家近的地方获得药物，这样他们就不会失去工作时间，等等。很多人已经服药多年，而且效果很好。目前，他们仍然需要频繁地（每1-3个月）到当地的诊所取药，这给他们和诊所都增加了负担。我们建议使用移动电话技术，看看我们是否可以帮助减轻这种负担。移动电话在撒哈拉以南的非洲地区很便宜，而且随处可见，很多人都在使用。事实上，许多人不用银行就用它们来汇款和做生意。我们将使用手机或平板电脑将患者记录和他们最近的血液检查与社区药房联系起来，这样患者就可以从多个地点获得药物，而不仅仅是他们的诊所。由于这种方法是新的，我们需要了解技术是如何工作的，了解病人、医生、护士、药房工作人员和政府对这个系统的看法，以及它对向病人提供服务的影响。我们还计划进行一项更大规模的研究，将这些技术与其他基于手机的工具联系起来，比如每天提醒吃药，看看我们如何将整个地理区域联系起来，并简化为艾滋病毒感染者提供的服务。如果成功的话，它可能会被用于成千上万正在接受艾滋病毒治疗的人，并且将来可能会被用于乌干达和撒哈拉以南非洲其他地区的高血压或糖尿病等其他疾病。

We have made great progress in getting life saving medication to people living with HIV all over the world. However, there are still around 15 million people worldwide who need treatment. This treatment is essential to stop people living with HIV from getting sick and dying, but it also helps to prevent new infections happening. As there are no vaccines for HIV at the moment and no cure, this is a very important form of preventing the spread of the infection. However, in many setting such as Uganda the cost of treating patients with HIV puts a great strain on the health services, and as more patients need treatment this will increase. Therefore, we need to find different ways of providing HIV treatment which will enable the health services to cope. This could include reducing the need for patients to see a doctor or nurse every time they go to clinic and so reduce the burden on staff, to reduce the paperwork involved, to make it easier for the patients to access their medication near to their homes, so that they do not lose working hours, and many more. Lots of people have now been on medication for a number of years and are doing very well. At the moment they still need to come frequently (every 1-3 months) to their local clinic to pick up medication which adds burden to both them and their clinic.We propose to use mobile phone technology to see if we can help to reduce this burden. Mobile phones are cheap and widely available in sub-Saharan Africa and very many people use them. In fact, many people use them to send money and do business, without the need for banks. We will use a mobile phone or tablet to link the patients records and their recent blood tests to community pharmacies, so that the patients can get their drugs from multiple sites, not just their clinic. As this approach is new we will need to see how the technology works, see what the patients, doctors and nurses, pharmacy staff and the government think about this system and to see what effect it is having on the delivery of services to the patients. We will also plan for a much larger research study which will link these technologies with other mobile phone based tools, such as daily reminders to take pills, and see how we can link up a whole geographical area and streamline the services for people living with HIV. If this works, it may be used for very many hundreds of thousands of people on HIV treatment, and in future may be used for other conditions such as high blood pressure or diabetes in Uganda and elsewhere in sub-Saharan Africa.