An mHealth implementation strategy to address the syndemic of mental illness, hypertension, and HIV in Uganda

解决乌干达精神疾病、高血压和艾滋病毒综合症的移动医疗实施战略

• 批准号: 10752992
• 负责人: Noeline Nakasujja
• 金额: $ 19.33万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-12 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10752992
• 关键词: Acquired Immunodeficiency Syndrome; Acute; Address; Africa South of the Sahara; Algorithms; Anxiety; Anxiety Disorders; Attention; Biological; Biosocial; Blood Pressure; Cardiovascular Diseases; Caregivers; Caring; Cellular Phone; Chronic; Clinic; Clinical; Clinical Trials; Collaborations; Complex; Data; Detection; Diagnosis; Disease; Dose; Economics; Effectiveness; Enrollment; Environment; Epidemic; Event; Evidence based intervention; Face; Funding; General Population; Goals; Government; Government Officials; HIV; Health Personnel; Health Priorities; Health Services Accessibility; Heart failure; Hybrids; Hypertension; Individual; Infrastructure; Intervention; Interview; Life; Link; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Mobile Health Application; National Institute of Mental Health; Outcome; Participant; Patients; Penetration; Persons; Phase; Poverty; Prevalence; Privatization; Process; Qualitative Methods; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Self Care; Severities; Shock; Site; Social Interaction; Stigmatization; Telephone; Testing; Text; Uganda; United States National Institutes of Health; Viral Load result; alcohol use disorder; arm; comorbidity; dashboard; digital platform; effectiveness evaluation; evidence base; human centered design; implementation measures; implementation science; implementation strategy; implementation study; implementation trial; improved; innovation; instrument; low and middle-income countries; mHealth; medication compliance; multidisciplinary; novel; patient engagement; pilot trial; primary outcome; programs; reduce symptoms; screening; secondary outcome; service delivery; social factors; social stigma; standard of care; syndemic; tailored messaging

There are 38 million people living with HIV (PLWH) worldwide, 68% of whom live in sub-Saharan Africa. With the transition of HIV from an acute illness to a chronic condition, co-morbid non-communicable diseases (NCDs) such as depression and anxiety disorder, alcohol use disorder (AUD), and hypertension (HTN) have become epidemic among PLWH. Despite evidence-based interventions to promote integration of these HIV comorbidities into HIV service delivery, integration efforts face challenges. First, integration commonly fails to recognize the syndemic relationships between these conditions and the deleterious effect of social factors such as poverty, stigma, and lack of access to care that worsen their outcomes, especially in low- and middle-income countries. Second, integration commonly imposes additional clinical tasks upon overburdened healthcare workers (HCW) operating in busy clinical environments without private space needed to attend to these additional conditions that are often stigmatized. A syndemic approach, which explicitly integrates the biological and social interactions that cause these conditions to cluster, has been proposed as a means of addressing the complex needs of PLWH. Mobile health (mHealth), an evidence-based strategy that leverages the widespread penetration of mobile phones to relieve HCW of burdensome tasks while enabling their systematic, consistent implementation, has been proposed as a solution to address HIV-related syndemics, but this approach has not been tested. Our exemplary multidisciplinary team has a strong track record of collaboration. In the current proposal, which leverages the infrastructure of an ongoing implementation study of HIV/HTN integration in Uganda, we will pursue these Specific Aims: Aim 1) Adapt Medly Uganda for detection, linkage to care, and ongoing support of depression, anxiety disorder, and AUD among Ugandans with HIV and HTN using a syndemic approach. Through human-centered design (HCD), we will engage patients, caregivers, and professional/lay HCW to guide iterative adaptation of Medly Uganda with explicit attention to common biosocial drivers. The adapted application will integrate widely used (1) screening instruments along with validated measures of significant life events, economic shocks, and stigma, (2) algorithm-driven messaging and alerts, and (3) linkage to HCW for support and treatment. We will also develop and operationalize a novel syndemic care cascade (R21 phase); Aim 2) Assess the effectiveness of the Syndemic-Adapted Medly Uganda (SAMU) to improve mental health care cascade metrics by conducting a single-arm trial using real-world historical data (R33 phase); Aim 3) Evaluate the factors impacting sustained engagement in the adapted Medly Uganda using mixed methods (R33 phase). Throughout the study period, we will focus on strengthening our Uganda-based team's mHealth research capacity and furthering our partnerships with government officials to ensure that SAMU can be locally maintained and sustained. The proposed study addresses a high priority topic for use of AIDS-designated funds at NIH and aligns with multiple National Institute of Mental Health priorities as described in PAR-21-303.

全世界有3800万人患有艾滋病毒（PLWH），其中68％居住在撒哈拉以南非洲。和 HIV从急性疾病过渡到慢性疾病，合并非通信疾病（NCDS） 抑郁症和焦虑症，酒精使用障碍（AUD）和高血压（HTN）已成为 PLWH中流行。尽管有循证干预措施以促进这些HIV合并症的整合 进入艾滋病毒服务提供，整合工作面临挑战。首先，集成通常无法识别 这些条件与社会因素（例如贫困）的有害影响之间的联合关系 污名，缺乏无法获得其结果的护理，尤其是在低收入和中等收入国家。 其次，集成通常在负担过重的医护人员（HCW）上实施其他临床任务（HCW） 在繁忙的临床环境中运行，没有私人空间需要处理这些其他条件 经常被污名化。联合方法，明确整合了生物学和社会互动 导致这些条件群集，已被提出是解决PLWH复杂需求的一种手段。 移动健康（MHealth），一种基于证据的策略，利用移动的广泛渗透 手机以减轻HCW的负担，同时实现其系统，一致的实施 被提议作为解决与HIV相关联合系统的解决方案，但尚未测试这种方法。我们的 典范的多学科团队拥有合作的良好记录。在当前的提议中 利用正在进行的HIV/HTN整合实施研究的基础设施，我们将 追求这些具体目的：目标1）适应乌干达梅德利的发现 乌干达人在患有艾滋病毒和HTN的抑郁症，焦虑症和AUD使用联合手术方法。 通过以人为本的设计（HCD），我们将吸引患者，看护人和专业/外行HCW指导 对乌干达的迭代适应，对常见的生物社会驱动因素有明确的关注。适用的应用程序 将整合广泛使用的（1）筛选工具以及验证的重大生活事件的措施， 经济冲击和污名，（2）算法驱动的消息传递和警报，以及（3）与HCW的联系以支持 和治疗。我们还将开发和运营一种新型的联合护理级联（R21阶段）；目标2） 评估联合适应的乌干达（SAMU）改善心理保健的有效性 级联指标通过使用现实世界历史数据（R33阶段）进行单臂试验；目标3）评估 使用混合方法（R33阶段）影响乌干达改编的梅德利持续参与的因素。 在整个研究期间，我们将专注于加强基于乌干达的团队的MHealth研究 能力并促进我们与政府官员的合作伙伴关系，以确保可以在本地维护SAMU 并持续。拟议的研究涉及在NIH和 如PAR-21-303中所述，与多个国家心理健康研究所保持一致。