Behavioral Aspects of Low-cost Medical Devices to Improve HIV Care

描述（由申请人提供）：撒哈拉以南非洲地区与艾滋病毒相关的死亡率仍然很高，部分原因是在监测和干预晚期疾病患者方面存在挑战。移动卫生技术，包括生物传感器和移动电话平台等，大有希望改善对高危艾滋病毒/艾滋病感染者的监测、沟通和有针对性的干预措施。然而，由于对人机界面的行为方面关注不足，这些技术中的大多数都没有实现。位于马萨诸塞州总医院的平价医疗技术联盟（CAMTech）正在开发一套强大的技术组合，以改善资源有限环境（RLS）中的医疗保健。我将通过评估CAMTech产品组合中的一种设备（用于远程检测异常生命体征的无线生物传感器），得出并验证一种行为科学框架，该框架适用于以患者为中心的新颖RLS技术。我的总体目标是成为接受和实施低成本医疗技术的研究领导者，以改善RLS的医疗服务，使用行为理论的基础来评估和解决技术接受的障碍。为了实现独立，我需要进一步的培训：1)定性研究方法，为以患者为中心的RLS干预制定技术接受理论框架；2)以RLS技术接受框架的开发和测试为重点的行为理论和分析方法；3)技术评价方面，包括临床研究方法和设备的技术要素，评估技术接受度并与工程师沟通结果。我的指导团队包括David Bangsberg博士，他是领导CAMTech的HIV治疗行为方面的专家，以及定性方法（Ware），行为理论和技术接受（Safren, Venkatesh），技术设计和实施（Fletcher, Remien）以及RLS临床研究设计和分析（Lockman, Mulogo, Petersen）方面的专家。在他们的指导下，我将通过以下具体目标来验证我的中心假设，即行为理论可以优化RLS中新技术的评估：1)使用定性研究方法建立与RLS中PLWHA相关的技术接受模型；2)从Aim 1中推导和测试测量紧急模型中的构念的量表；3)使用目标1和2中衍生的框架，对生物传感器的可接受性和可行性进行试点研究，以识别高危艾滋病患者的异常生命体征。该研究计划具有创新性，因为它将得出并测试一个适用于众多有前途的低成本技术的框架，以改善RLS的医疗保健服务。此外，这将使我能够申请NIH R01来测试这个和其他设备的功效。基于我在乌干达的成功研究、强大的指导团队以及美国和乌干达的机构支持，我完全有能力实现这些目标。

DESCRIPTION (provided by applicant): HIV-related mortality in sub-Saharan Africa remains high, partly due to challenges with monitoring and intervening on patients presenting with advanced disease. Mobile health technologies, including biosensors and cellular phone platforms, among others, hold great promise to improve monitoring, communication and targeting of interventions to at-risk people living with HIV/AIDS (PLWHA). Yet, the majority of these technologies are not implemented due to inadequate attention to behavioral aspects of the human- technology interface. The Consortium for Affordable Medical Technologies (CAMTech), based at the Massachusetts General Hospital, is developing a robust portfolio of technologies for improving healthcare in resource limited settings (RLS). I will derive and validate a behavioral science framework of technology acceptance for novel, patient-centered technologies in RLS by evaluating 1 device in the CAMTech portfolio, a wireless biosensor for remote detection of abnormal vital signs. My overarching goal is to become a leader in the study of acceptance and implementation of low-cost medical technologies to improve healthcare delivery in RLS, using a foundation in behavioral theory to evaluate and address barriers to technology acceptance. To achieve independence, I require further training in: 1) qualitative research methods to derive a technology acceptance theoretical framework for patient-centered interventions in RLS; 2) behavioral theory and analysis methods focused on developing and testing technology acceptance frameworks in RLS; and 3) aspects of technology evaluation, including clinical research methods and technical elements of devices, to evaluate technology acceptance and communicate results with engineers. My mentoring team includes Dr. David Bangsberg, an expert in behavioral aspects of HIV treatment who leads CAMTech, and experts in qualitative methods (Ware), behavioral theory and technology acceptance (Safren, Venkatesh), technology design and implementation (Fletcher, Remien), and clinical study design and analysis in RLS (Lockman, Mulogo, Petersen). With their guidance, I will test my central hypothesis that behavioral theory can optimize the evaluation of novel technologies in RLS, through the following specific aims: 1) develop a technology acceptance model relevant to PLWHA in RLS using qualitative research methods; 2) derive and test scales to measure constructs in the emergent model from Aim 1; and 3) using the framework derived in Aims 1 and 2, perform a pilot study of acceptability and feasibility of the biosensor to identify abnormal vitl signs in at-risk PLWHA. The research plan is innovative because it will derive and test a framework applicable to the multitude of promising low-cost technologies to improve healthcare delivery in RLS. Further, it will position me to apply for an NIH R01 to test the efficacy of this and other devices. I am well positioned to accomplish these aims based upon my success conducting research in Uganda, strong mentoring team, and institutional support both in the United States and Uganda.