Screen Smart: Using Digital Health to Improve HIV Screening and Prevention for Adolescents in the Emergency Department

智能屏幕：利用数字健康改善急诊科青少年的艾滋病毒筛查和预防

• 批准号: 10711679
• 负责人: Nadia L Dowshen
• 金额: $ 87.19万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-13 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10711679
• 关键词: AIDS prevention; Accident and Emergency department; Accounting; Acute; Address; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Affect; Applied Research; Appointment; Awareness; Behavior; Caring; Centers for Disease Control and Prevention (U.S.); Chlamydia; Clinical; Collaborations; Collection; Computers; Country; Data; Data Reporting; Detection; Development; Diagnosis; Education; Effectiveness; Electronic Health Record; Electronics; Eligibility Determination; Emergency Care; Emergency department visit; Epidemic; Goals; Gonorrhea; HIV; HIV-infected adolescents; HIV/AIDS; Health; Health Technology; Healthcare; Home; Hour; Human immunodeficiency virus test; Infection; Interruption; Intervention; Link; Literature; Location; Logistics; Measures; Medical; Methods; Patient Outcomes Assessments; Patients; Pediatric Hospitals; Persons; Policies; Population; Prevention; Prevention program; Prevention strategy; Preventive care; Preventive healthcare; Primary Care; Process; Provider; Public Health; Recommendation; Research; Risk; Series; Services; Sexual Health; Source; Tablets; Testing; Text Messaging; Time; United States; Viral; Visit; Work; Youth; age group; candidate identification; clinical decision support; clinical practice; computed tomography screening; computerized; cost effective; design; digital health; evidence base; follow-up; health care settings; high risk; high risk sexual behavior; implementation strategy; improved; innovation; insight; interest; mHealth; novel; pediatric emergency; pragmatic trial; pre-exposure prophylaxis; preference; prevent; primary care services; primary care setting; provider adherence; response; screening; screening program; seroconversion; stem; telehealth; treatment adherence; uptake

Project Summary: Adolescents and young adults (AYA) are disproportionately affected by HIV in the US. Despite adolescents accounting for over 20% of new infections, this age group is the least likely to be tested for HIV, linked to care, and achieve viral suppression when compared to their adult counterparts. Further, AYA also have low rates of HIV awareness and initiation of HIV Pre-Exposure Prophylaxis (PrEP). Therefore, there is an urgent need to expand HIV screening and prevention strategies to nontraditional healthcare settings such as emergency departments (ED) to reach those adolescents who would otherwise not receive preventive healthcare. The goal of this application is to leverage our recent insights obtained from a multi-center, ED-based, adolescent gonorrhea and chlamydia screening study and apply them across a national pediatric ED research network by (1) adapting, refining, and testing this process to increase universally offered, opt-out HIV screening among adolescents in the pediatric ED and (2) link at-risk adolescents to PrEP services and preventive care. This will be accomplished through a network of children’s hospital EDs with a track record of robust research collaboration (Pediatric Emergency Care Applied Research Network or PECARN). This research will contribute to the evidence base for creating clinically effective and sustainable HIV screening programs that can be successfully implemented into the clinical workflow of the ED. It will also improve identification and linkage to PrEP care for at risk adolescents using mHealth strategies by first identifying AYA who are PrEP candidates based on their responses to a computerized sexual health screen (cSHS) and subsequently (1) providing clinical decision support to providers via the electronic health record and (2) direct text messaging from the cSHS to PrEP candidates providing educational content and connecting youth to a PrEP navigator. This intervention will rely on an innovative approach that electronically integrates patient-reported data to guide clinical decision support. This work is significant because it has the potential to shift current ED clinical practice paradigms from only acute health encounters to participation in the broader management of public health and prevention, and it will fill gaps in the literature needed to provide evidence for the best method of HIV screening in a pediatric ED setting. Using a previously developed tablet-based, broad scale GC/CT screening process, we will adapt, refine, and test this process with the aim of increasing universally offered, opt-out HIV screening in the pediatric ED through electronic integration of patient reported data for provision of clinical decision support for HIV screening and identification of PrEP candidacy, and then use mHealth to link patients to PrEP services. This research is novel in that it shifts the usual clinical practice paradigm of HIV screening and prevention in the pediatric ED from a scattered approach to a consistent and sustainable approach that is critical to addressing the HIV epidemic among adolescents.

项目摘要： 在美国，青少年和年轻人（AYA）受艾滋病毒的影响不成比例。尽管青少年 该年龄组占新感染的20％以上，对艾滋病毒的测试最少，与护理有关 与成人相比，并获得病毒抑制。此外，aya的比率也很低 HIV意识和HIV暴露前预防的倡议（PREP）。因此，迫切需要 将艾滋病毒筛查和预防策略扩展到非传统医疗保健环境，例如紧急情况 部门（ED）接触那些否则不会获得预防性医疗保健的青少年。目标 此应用程序是利用我们从基于多中心的青少年获得的最新见解 淋病和衣原体筛查研究，并将它们应用于国家儿科研究网络（1） 适应，精炼和测试此过程以增加普遍提供的，选择退出HIV筛查 儿科ED的青少年和（2）将高风险的青少年与预防服务联系起来。这将是 通过儿童医院的ED网络完成，并具有强大的研究合作记录 （小儿紧急护理应用研究网络或PECARN）。这项研究将有助于 创建临床有效和可持续的艾滋病毒筛查计划的证据基础，可以成功 实施到ED的临床工作流程中。它还将改善识别和联系以进行准备 风险青少年使用MHealth策略，首先确定基于他们的准备候选者的AYA 对计算机性健康屏幕（CSHS）的响应，随后（1）提供临床决定 通过电子健康记录和（2）从CSHS到PREP的直接文本消息对提供商的支持 候选人提供教育内容，并将青年与预备导航员联系起来。这种干预将依靠 一种创新的方法，通过电子方式整合患者报告的数据以指导临床决策支持。这 工作很重要，因为它有可能将当前ED临床实践范式从急性转移 健康遇到参与更广泛的公共卫生和预防管理，它将填补空白 在文献中，需要在儿科环境中提供最佳的艾滋病毒筛查方法的证据。使用 先前开发的基于平板电脑的大规模GC/CT筛选过程，我们将适应，完善和测试 过程以增加普遍提供的儿科筛查的艾滋病毒筛查的目的 电子整合患者报告的数据，用于提供HIV筛查的临床决策支持和 识别候选准备人员，然后使用MHealth将患者与预备服务联系起来。这项研究是新颖的 它改变了儿科筛查和预防的常规临床实践范式 分散的方法采用一致且可持续的方法，这对于解决艾滋病毒流行至关重要 在青少年中。