Seek, Test, Treat and Retain strategies leveraging mobile health technologies

描述（由申请人提供）：识别、检测、治疗和保留新诊断的艾滋病毒感染者是一个重要的机会，可以通过将他们与先前未被怀疑的严重疾病联系起来来改善个人健康，并通过影响传播的风险因素来影响公共卫生。当新发现的艾滋病毒感染者和药物使用障碍患者在安全网环境中得到管理时，他们本已复杂的保健需求因高比例的保健文盲和缺乏获得保健信息的机会而进一步复杂化。互联网启用的个人健康记录（PHR）为患者提供了获得健康信息，健康技术和更密切的联系，他们的卫生系统。手机是另一种改善患者与其护理中心之间联系（以及信息交换）的工具。虽然互联网和手机连接是互补的技术，但手机比互联网更容易被许多弱势患者使用。因此，蜂窝连接和这些网络上可用的工具可能对改善安全网环境中患者的医疗保健至关重要，并可能在将这些患者与医疗保健系统联系起来方面发挥重要作用。互联网和移动电话技术为帮助艾滋病/艾滋病毒患者，特别是同时患有药物使用障碍的患者接受护理提供了新的和可持续的机会，最终目标是改善获得信息的机会，并提供自我管理其保健的工具。在这个应用程序中，我们提出了一个创新，教导和培训新诊断的艾滋病毒感染者利用部署的互联网和蜂窝技术，并开发新的应用程序，以帮助连接到护理和改善治疗结果。在本项目中，我们将确定患者使用互联网和蜂窝技术（根据患者的意见设计，旨在帮助患者自我管理健康）的培训对转诊的影响，并通过预约，保留护理以及启动和维持适当的抗逆转录病毒治疗。我们将利用以前未应用于新发现的艾滋病毒感染人群的已开发和部署的技术，以确定互联网和蜂窝技术是否改善了重要的生物，社会和健康相关结果。目标人群，即在安全网环境中接受护理的新确定的艾滋病毒感染者，满足了另一项重要需求：了解安全网中的病人如何获得和利用技术工具。我们的研究结果可能会确定方法，以缩小日益增长的信息技术（IT）在这个国家的差距，并减少排除这些患者从健康相关的IT举措。我们的研究结果可能会为其他场所实施基于Web和蜂窝的创新提供信息。我们假设，经过培训和教育的患者使用基于网络和蜂窝平台将证明在医疗保健需求的自我管理，护理保留和药物依从性方面的改善，共同有助于改善健康结果。 公共卫生相关性：艾滋病毒/艾滋病是一种严重的疾病，及时发现艾滋病毒感染者，然后开始有效的抗逆转录病毒治疗，可以延长生命，而且具有成本效益。识别、检测、治疗和留住新诊断的艾滋病毒感染者是改善个人健康的一个重大机会，因为这可以将他们与未被怀疑的严重疾病联系起来，并可能影响导致病毒在社区内传播的风险因素。当新发现的艾滋病毒感染者和药物使用障碍患者在安全网环境中得到管理时，他们本已复杂的保健需求因高比例的保健文盲和缺乏获得保健信息的机会而进一步复杂化。尽管有多种治疗方法，但有充分证据表明，健康状况不佳的人（非裔美国人、妇女和注射毒品使用者）可能更难获得快速诊断和治疗，坚持治疗也有问题，因此艾滋病毒健康并发症更多。虽然互联网和手机连接是互补的技术，但在许多弱势患者中，手机比互联网更常用。因此，蜂窝连接和这些网络上可用的工具可能对改善安全网环境中患者的医疗保健至关重要，并将在将这些患者与其医疗保健系统联系起来方面发挥重要作用。我们已经在我们的诊所实施了慢性病护理模式，并将重点放在有效的临床信息系统上，并表明个人健康记录（PHR）是患者访问其临床信息，与临床医生沟通和回答调查问题的平台。在这个应用程序中，我们建议教和培训新诊断的艾滋病毒感染者利用互联网和蜂窝技术，以协助连接到护理和改善护理的结果。我们的研究结果可以确定缩小日益增长的信息技术（IT）差距的方法，并减少将这些患者排除在与健康相关的IT计划之外。

DESCRIPTION (provided by applicant): Identifying, testing, treating and retaining persons with newly diagnosed HIV infection represents a substantial opportunity to improve the health of individuals by linking them into care for a previously unsuspected serious condition and to impact public health by influencing risk factors for transmission. When patients with newly identified HIV infection and with substance use disorders are managed in a safety net setting, their already complex healthcare needs are further compounded by high rates of health illiteracy and a lack of access to health information. Internet enabled personal health records (PHRs) provide patients with access to health information, health technology and closer connections to their health systems. Cell phones are another tool for improving connections between patients and their care centers (and for information exchange). Although internet and cellular connections are complementary technologies, cell phones are more accessible to many disadvantaged patients than the internet. Thus cellular connections and the tools available on these networks may prove critically important to improve healthcare for patients in the safety net setting and could play an important role in linking these patients to the health care system. Internet and cellular technologies present new and sustainable opportunities to help AIDS/HIV patients stay in care, especially individuals with co-occurring substance use disorders, with the ultimate goal of improving access to information and providing tools for self-management of their healthcare. In this application we propose an innovation to teach and train newly diagnosed HIV infected individuals to utilize deployed internet and cellular technologies and develop novel applications to assist with linkages to care and improve treatment outcomes. In this project we will determine the impact from patient training in the use of internet and cellular technologies (designed with patient input and built to assist patients self-manage their health) on referrals and follow through with appointments, retention in care and the initiation and sustaining of appropriate antiretroviral treatment. We will utilize developed and deployed technologies that have not been applied previously to the newly identified HIV infected population to determine if internet and cellular technologies improves important biologic, social and health-related outcomes. The target population, newly identified persons with HIV infection receiving care in a safety net setting, meets an additional critical need: to understand how patients in the safety net access and utilize technology tools. Our findings may identify methods to narrow the growing information technology (IT) gap in this country and reduce exclusion of these patients from health-related IT initiatives. Our results will likely inform implementation of Web-based and cellular innovations in other venues. We hypothesize that patients trained and educated to use Web-based and cellular platforms will demonstrate improvements in self-management of healthcare needs, retention in care, and medication adherence, collectively contributing to improved health outcomes. PUBLIC HEALTH RELEVANCE: HIV/AIDS is a serious illness and timely identification of persons with HIV infection followed by the initiation of effective antiretroviral treatment prolongs life and is cost effective. Identifying, testing, treating and retaining persons with newly diagnosed HIV infection represents a substantial opportunity to improve the health of individuals by linking them into care for an unsuspected serious condition, and perhaps influence risk factors that contribute to viral spread within a community. When patients with newly identified HIV infection and with substance use disorders are managed in a safety net setting, their already complex healthcare needs are further compounded by high rates of health illiteracy and a lack of access to health information. Despite the multiple approaches to treatment there is ample evidence that persons with experiencing health disparities (African-Americans, women and injection drug users) may have poorer access to rapid diagnosis, treatment and problematic adherence and thus have greater HIV health complications. Although internet and cellular connections are complementary technologies, among many disadvantaged patients cell phones are more commonly used than then the internet. Thus cellular connections and the tools available on these networks may prove critically important to improve healthcare for patients in the safety net setting and will be play an important role to link these patients to their health care system. We have implemented the Chronic Care Model in our clinic and placed our emphasis on effective clinical information systems and have shown that the personal health records (PHRs) are a platform for patients to access their clinical information, to communicate with their clinicians and to respond to survey questions. In this application we propose to teach and train newly diagnosed HIV infected individuals to utilize internet and cellular technologies to assist linkages to care and improve outcomes of care. Our findings may identify methods to narrow the growing information technology (IT) gap and reduce exclusion of these patients from health-related IT initiatives.