Using mHealth to Respond Early to Acute Exacerbations of COPD in HIV_ mREACH

利用移动医疗对 HIV 患者慢性阻塞性肺病急性加重做出早期反应_mREACH

• 批准号: 8551692
• 负责人: Gregory D Kirk
• 金额: $ 60.96万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-26 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8551692
• 关键词: Accident and Emergency department; Acute; Address; Adherence; Cardiovascular system; Cause of Death; Characteristics; Chronic Obstructive Airway Disease; Clinic; Clinical; Clinical Trials; Cohort Studies; Comorbidity; Complex; Data; Databases; Development; Diagnosis; Early Intervention; Early identification; Early treatment; Effectiveness; Effectiveness of Interventions; Elements; Ensure; Etiology; Future; Goals; Grant; HIV; HIV Infections; HIV Seropositivity; Health; Health Technology; Healthcare; Home environment; Hospitals; Incidence; Individual; Intervention; Longitudinal Studies; Lung; Lung diseases; Measurement; Measures; Medical; Methods; Monitor; Morbidity - disease rate; Obstruction; Obstructive Lung Diseases; Outcome; Participant; Patient Care; Patient Self-Report; Patients; Pattern; Performance; Persons; Pharmaceutical Preparations; Phenotype; Pilot Projects; Population; Predisposition; Preparation; Prevalence; Provider; Quality of life; Questionnaires; Randomized; Recurrence; Reporting; Research Infrastructure; Respiratory physiology; Risk; Risk Factors; Role; Severities; Smoking; Spirometry; Structure; Subgroup; Symptoms; Target Populations; Tobacco use; Validation; Variant; Visit; Wireless Technology; antiretroviral therapy; base; clinical care; clinical practice; cohort; cost; data modeling; design; disease diagnosis; effective intervention; health application; high risk; improved; innovation; longitudinal analysis; randomized trial; respiratory; response; screening; tool; tool development; treatment as usual

DESCRIPTION (provided by applicant): In response to HL-12-034: Management of HIV-related Lung Disease and Cardiovascular Co-morbidity, we propose to develop methods to improve recognition of chronic obstructive pulmonary disease (COPD) and to mitigate acute exacerbations of COPD (AECOPD) among HIV-infected individuals. Our hypothesis is that earlier identification of acute exacerbations through in-home monitoring of respiratory symptoms, lung function and medication usage will allow appropriate intervention to reduce the morbidity associated with AECOPD. Therefore, we propose using innovative mobile health (mHealth) applications to Respond Early to Acute exacerbations of COPD in HIV (mREACH). mHealth interventions in the HIV-COPD setting hold promise, but prior to embarking on costly clinical trials, methods for improving COPD recognition, for defining the high-risk subset most likely to benefit, and for optimizing the appropriate mHealth technology are needed. COPD remains greatly under-recognized among HIV-infected persons; improving recognition is a requisite first step prior to any intervention. Building on existing data and infrastructure of our on-going HIV-COPD longitudinal studies, we will develop an HIV-specific COPD screening tool to be applied to HIV clinic populations. Evaluating both symptom-based and clinical case definitions, we will characterize risk factors for AECOPD to inform targeting of appropriate participants in future trials. Then, among HIV-infected individuals with spirometry-confirmed COPD, we will conduct a pilot randomized trial of mHealth monitoring compared to usual care to reduce the symptom and clinical burden of AECOPD. Results from this clinical trial planning grant will allow assessment of the feasibility and acceptability of our mHealth applications, guide refinement of the intervention and generate preliminary efficacy data to inform design of future, definitive trials. If effective, the results of this trial will improve the identification, risk statification and management of AECOPD among the high-risk yet underserved HIV-infected population.

描述（由申请人提供）：响应HL-12-034：与HIV相关的肺部疾病和心血管合并症的治疗，我们建议开发方法以提高对HIV受感染的人群COPER（AECD）的慢性阻塞性肺部疾病（COPD）的认识，以减轻对COPD（AECD）的急性急性促进。我们的假设是，通过在家监测呼吸道症状，肺功能和用药使用情况下，早期鉴定出急性加重，将允许适当的干预措施降低与AECOPD相关的发病率。因此，我们建议使用创新的移动健康（MHealth）应用程序对COPD急性加重艾滋病毒（MREACH）提早反应。在HIV-COPD设置中的MHealth干预措施具有承诺，但是在进行昂贵的临床试验，改善COPD识别的方法之前，需要定义最有可能受益的高风险子集，并且需要优化适当的MHEAXTH技术。在感染HIV的人中，COPD仍然被低估了；改善识别是任何干预之前必要的第一步。基于我们的现有数据和基础架构 正在进行的HIV-COPD纵向研究，我们将开发一种HIV特异性COPD筛查工具，可应用于HIV临床人群。评估基于症状的和临床病例定义，我们将表征AECOPD在以后的试验中为适当参与者提供针对适当参与者的风险因素。然后，在感染了肺活量测定确认的COPD的HIV感染者中，我们将与通常的护理相比，对MHealth监测进行随机试验，以减轻AECOPD的症状和临床负担。这项临床试验计划赠款的结果将允许评估我们的MHealth申请的可行性和可接受性，指南 干预措施的完善并产生初步疗效数据，以告知未来，确定试验的设计。如果有效，则该试验的结果将改善高危尚未得到的HIV感染人群中AECOPD的识别​​，风险统计和管理。