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

描述（由申请人提供）：南非有610万艾滋病毒感染者，是世界上艾滋病毒感染者人数最多的LMIC。为了解决由此造成的医疗保健人员短缺问题，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。神经认知障碍（NCI）是HIV感染最常见的后遗症和共病症状之一，具有显著的医疗、功能和公共卫生后果。NCI影响超过一半的艾滋病毒感染者，但在临床环境中往往未被发现。虽然-与其他慢性病一样-艾滋病毒非传染性疾病的常规筛查可以加强医患沟通，促进药物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。 移动的技术可以为这一关键的公共卫生和医疗保健挑战提供解决方案，促进对艾滋病毒和其他慢性疾病的NCI进行常规筛查。为此，我们开发了NeuroScreen，这是一款适用于Android设备的简单易用的NCI筛查测试应用程序，旨在由临床环境中的广泛非专家医疗保健人员进行管理。该应用程序是标准化和高度自动化的，需要最少的培训来管理，并且不需要记录或评分。它可用于诊所检查室、偏远农村地区和/或家庭访视，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”，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）调整NeuroScreen，以供南非科萨语非专业顾问管理;（2）评估顾问管理的应用程序在100名HIV+成人中检测NCI的灵敏度和特异性，以及其可用性和 可接受性;和（3）探索NeuroScreen结果和医疗健康结果之间的关联-即，ART治疗失败的客观行为和生物标志物。这些数据将成为未来更大规模研究的基础，研究如何在低收入国家环境中实施和扩大这一移动健康工具。NeuroScreen可以很容易地进行修改，用于其他疾病和LMIC，这些疾病和LMIC由于医疗资源有限而依赖于任务转移。 该项目将以几种方式建设南非的研究能力。首先，我们的国内合作者和合作伙伴在制定这一建议将继续与我们合作，在未来的研究基础上，这项研究。第二，这项研究将建立南非软件开发人员的能力，将其专业知识应用于公共卫生和临床研究。第三，我们将在卫生部诊所和开普敦大学提供关于NCI和移动健康工具的在职培训，并向UCT医疗和研究学员传播研究结果和经验教训，并举办关于开发和实施移动健康研究和工具的研讨会。

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.