Improving HIV Care with mHealth Tools: An App to Detect Neurocognitive Impairment

 描述（由申请人提供）：神经认知障碍（NCI）是HIV中最常见的临床症状之一，影响多达70%的感染者，包括接受抗逆转录病毒治疗（ART）和病毒血症控制良好的患者。在HIV中观察到的NCI具有显著的医学、功能和公共卫生后果（例如，坚持ART的问题），但在临床环境中往往未被发现。对HIV相关NCI进行常规筛查可以加强医患沟通，帮助NCI患者更好地管理他们的ART依从性和其他健康结果，但这样做面临挑战。例如，HIV诊所中用于NCI的大多数筛查工具是容易发生管理和评分错误的纸笔测试，其需要训练有素的人员来管理、评分和解释，需要额外的设备，并且不太适合使用电子医疗记录的现代诊所。为了解决这一公共卫生和医疗实践的差距，我们开发了一种移动健康工具，使筛查在现代临床环境中更容易获得和可持续。NeuroScreen是一款简单易用的NCI筛查测试应用程序（应用程序），适用于Android移动的设备，旨在由广泛的非专家医疗保健人员管理。该应用程序是高度自动化的（例如，不需要任何记录保存或评分），标准化的说明确保每次给药的一致性，只需最少的培训。NeuroScreen是超便携的（即，可用于任何诊所检查室、偏远和乡村环境，或在家庭访问期间）和完全独立的（即，不需要纸质表格、笔、秒表或其它设备）。NeuroScreen的结果可立即提供，并可通过电子方式传送给各种最终用户，如初级保健提供者、艾滋病毒专家和/或电子病历，以及人口水平监测数据库。本研究将评估不同专业水平的HIV护理提供者（例如，医生、护士和病例管理人员），并确定提供者和诊所级别的促进者和障碍，将此移动健康工具整合到临床实践中。然后，该研究将评估NeuroScreen在182名患有NCI（n=91）和没有NCI（n=91）的HIV感染成人中检测轻度NCI的准确性。通过易于使用和准确的工具来检测NCI，并且非常适合使用和转向电子医疗系统的诊所，可以实现早期检测和持续监测损伤，并帮助医疗保健提供者更有效地与患者沟通他们的治疗和护理，更好地转诊，并提供量身定制的ART依从性干预措施和策略以及艾滋病毒预防服务。此外，NeuroScreen为卫生系统提供了一种可行的方法，可以收集大量适合人群流行病学研究和其他利用大数据的研究的神经认知数据。像NeuroScreen这样的移动健康工具可以很容易地进行修改，以用于世界上其他疾病人群和地区，这些人群和地区由于医疗资源非常有限而依赖于任务转移。

 DESCRIPTION (provided by applicant): Neurocognitive impairment (NCI) is one of the most common clinical conditions seen in HIV, affecting as many as 70% of infected individuals, including those on antiretroviral therapy (ART) and with well-controlled viremia. The NCI seen in HIV has significant medical, functional, and public health consequences (e.g., problems adhering to ART), but often goes undetected in the clinical setting. Routine screening for HIV-related NCI can enhance provider-patient communication to help patients with NCI better manage their ART adherence and other health outcomes, but doing so faces challenges. For instance, most screening tools for NCI in HIV clinics are paper-and-pencil tests prone to administration and scoring errors that require highly trained personnel to administer, score and interpret, require additional equipment, and are not well-suited for modern clinics utilizing electronic medical records. To address this public health and medical practice gap, we have developed an mHealth tool to make screening more accessible and sustainable in the modern clinical setting. NeuroScreen is a brief, easy-to-use NCI screening test application (app) for Android mobile devices designed to be administered by a wide range of non-expert healthcare personnel. The app is highly automated (e.g., does not require any record keeping or scoring) with standardized instructions ensuring consistent administrations each and every time with minimal training. NeuroScreen is ultra-portable (i.e., usable in any clinic exam room, remote and rural settings, or during home visits) and totally self-contained (i.e., no need for paper forms, pens, stopwatches, or other apparatuses). Results from NeuroScreen are available immediately and can be transmitted electronically to a variety of end-users, such as primary care providers, HIV specialists and/or electronic medical records, as well as to databases for population level monitoring. This study will assess the usability and acceptability of a tablet-based NeuroScreen by HIV care providers of differing expertise levels (e.g., physicians, nurses, and case managers), and identify provider- and clinic-level facilitators and barriers to integrating this mHealth tool into clinical practice. The study will then evaluate NeuroScreen's accuracy to detect mild NCI in 182 HIV-infected adults with NCI (n=91) and without NCI (n=91). With an easy-to-use and accurate tool to detect NCI and well-suited for clinics using and moving towards electronic medical systems, early detection and on-going monitoring of impairment could be realized and help healthcare providers communicate more effectively with patients about their treatment and care, make better referrals, and offer tailored ART adherence interventions and strategies as well as HIV prevention services. Furthermore, NeuroScreen offers health systems a viable method to collect large quantities of neurocognitive data suited to population level epidemiological research and other studies utilizing big data. An mHealth tool, like NeuroScreen, could be easily modified for use in other disease populations and regions of the world that rely on task-shifting due to very limited healthcare resources.