aReproductive, Maternal, Newborn, and Child Health Department, FHI360, Durham, North Carolina, USA bAsia Pacific Regional Office, FHI360, Bangkok, Thailand.
Curr Opin HIV AIDS. 2017 Sep;12(5):475-487. doi: 10.1097/COH.0000000000000402.
HIV prevention and care is changing rapidly; guideline revisions and programmatic scale-up require innovative approaches to in-service training and care extension to improve provider practice and care access. We assessed recent (≤12 months) peer-reviewed publications on electronic health (eHealth), telemedicine, and other innovative provider-targeted interventions for HIV-related care.
Key developments included systems merging electronic medical records (EMR) with provider clinical decision aids to prompt action, demonstration eHealth, and telemedicine projects, reviews or descriptions of technology to improve connectivity in lower resource settings, and a few trials on provider-centered interventions. Most publications were program reports and few data were available regarding efficacy of eHealth interventions for providers on patient HIV-related outcomes, notably identification and management of antiretroviral treatment failure in Kenya. Better evidence is needed for strategies to train providers and care extenders with the goal to improve impact of HIV prevention and care interventions.
Rapid technology introduction and expansion may change the paradigm for improving provider knowledge and practice. Although new, the developments are promising for HIV provider-targeted eHealth and innovations for traditional training. More rigorous testing with randomized trials is needed to demonstrate impact on services for people living with HIV.
目的综述：艾滋病病毒预防和护理正在迅速发展；指南修订和方案扩大需要创新的在职培训和护理延伸方法，以改善服务提供者的实践和护理可及性。我们评估了最近（≤12 个月）关于电子健康（eHealth）、远程医疗和其他创新面向服务提供者的干预措施的同行评议出版物，这些措施与艾滋病毒相关护理有关。
最新发现：关键的发展包括将电子病历（EMR）与提供者临床决策支持系统合并，以提示采取行动、展示电子健康和远程医疗项目、审查或描述改善较低资源环境下连接性的技术，以及一些关于以提供者为中心的干预措施的试验。大多数出版物是项目报告，关于电子健康干预措施对提供者在患者艾滋病病毒相关结果方面的效果的数据很少，特别是在肯尼亚识别和管理抗逆转录病毒治疗失败方面。需要更好的证据来制定培训提供者和护理延伸者的战略，以提高艾滋病病毒预防和护理干预措施的效果。
总结：快速引入和扩展技术可能会改变改善提供者知识和实践的模式。尽管这些发展是新的，但对于针对艾滋病毒提供者的电子健康和传统培训的创新来说，它们是有希望的。需要进行更严格的随机试验测试，以证明其对艾滋病毒感染者服务的影响。
