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

基本信息

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
项目类别：
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

项目摘要

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.

全球有 3800 万艾滋病毒感染者 (PLWH)，其中 68% 生活在撒哈拉以南非洲地区。和 HIV 从急性疾病转变为慢性疾病、共病非传染性疾病 (NCD) 例如抑郁症和焦虑症、酒精使用障碍（AUD）和高血压（HTN）已成为 PLWH 中流行。尽管有基于证据的干预措施来促进这些艾滋病毒合并症的整合在艾滋病毒服务提供方面，整合工作面临挑战。首先，整合通常无法识别这些状况与社会因素（例如贫困、耻辱和缺乏获得护理的机会使他们的结果恶化，特别是在低收入和中等收入国家。其次，整合通常会给负担过重的医护人员（HCW）带来额外的临床任务在繁忙的临床环境中操作，没有私人空间来处理这些额外的条件经常受到污名化。一种流行病方法，明确整合了生物和社会相互作用，导致这些情况集中的原因，已被提议作为解决 PLWH 复杂需求的一种手段。移动医疗 (mHealth)，一种利用移动设备广泛普及的循证策略电话可以减轻医护人员的繁重任务，同时能够系统、一致地实施这些任务，被提议作为解决艾滋病毒相关综合症的解决方案，但这种方法尚未经过测试。我们的堪称典范的多学科团队拥有良好的协作记录。在目前的提案中，利用乌干达正在进行的 HIV/HTN 整合实施研究的基础设施，我们将追求这些具体目标：目标 1) 适应 Medly 乌干达的检测、与护理的联系以及持续支持使用联合流行病方法对乌干达 HIV 和 HTN 患者进行抑郁、焦虑症和 AUD 评估。通过以人为本的设计 (HCD)，我们将让患者、护理人员和专业/非专业医护人员参与指导 Medly Uganda 的迭代适应，明确关注常见的生物社会驱动因素。适应的应用程序将整合广泛使用的 (1) 筛查仪器以及重大生活事件的经过验证的测量，经济冲击和耻辱，(2) 算法驱动的消息传递和警报，以及 (3) 与 HCW 联系以获得支持和治疗。我们还将开发并实施一种新型的流行病护理级联（R21 阶段）；目标2) 评估乌干达流行病适应医疗计划 (SAMU) 在改善精神卫生保健方面的有效性通过使用真实历史数据进行单臂试验来级联指标（R33 阶段）；目标 3) 评估使用混合方法（R33 阶段）在改编后的乌干达 Medly 中影响持续参与的因素。在整个研究期间，我们将重点加强乌干达团队的移动医疗研究能力并进一步加强我们与政府官员的合作关系，以确保 SAMU 能够在当地得到维持并持续。拟议的研究涉及 NIH 和 NIH 艾滋病指定资金使用的高度优先主题。符合 PAR-21-303 中所述的多个国家心理健康研究所优先事项。