Fee Connie, Fuller Julia, Guss Carly E, Woods Elizabeth R, Cooper Ellen R, Bhaumik Urmi, Graham Dionne, Burchett Sandra K, Dumont Olivia, Martey Emily B, Narvaez Maria, Haberer Jessica E, Swendeman Dallas, Mulvaney Shelagh A, Kumar Vikram S, Jackson Jonathan L, Ho Y Xian
University of San Francisco, San Francisco, CA, United States.
Dimagi, Inc, Cambridge, MA, United States.
JMIR Form Res. 2022 Nov 21;6(11):e39357. doi: 10.2196/39357.
Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today.
The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages).
We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively.
The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study.
Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life.
ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066.
近年来医学治疗的进展促使青年中与艾滋病病毒相关的机会性感染和死亡总体有所下降；然而，如今围产期和非围产期感染艾滋病病毒的青少年和青年成人（AYA）的死亡率和发病率仍然相对较高。
本项目的目标是评估PlusCare的使用情况、效用和成本效益，PlusCare是一款用于感染艾滋病病毒的AYA病例管理的数字应用程序。该应用程序支持常规病例管理任务，如安排随访就诊、共享供审核和签名的文件、实验室检查结果以及就诊期间的沟通（如鼓励信息）。
我们在波士顿都会区的两家大型城市医院与艾滋病病毒病例管理项目开展了一项单组混合方法前后对照研究。病例管理人员（病例管理员[CMs]，N = 20）和感染艾滋病病毒的AYA参与者（N = 45）参与了该研究，分别可使用PlusCare长达15个月和12个月。
CMs和感染艾滋病病毒的AYA报告的系统可用性量表平均得分分别为51（标准差7.9）和63（标准差10.6）。虽然差异不显著，但与应用程序使用前的12个月相比，两个地点之一的总收费（包括急诊、住院和门诊收费）下降了41%（P = 0.046）。我们还观察到，从基线到12个月随访期间，感染艾滋病病毒的AYA自我报告的慢性病管理自我效能和生活质量（健康相关生活质量-4）略有提高（分别为P = 0.02和P = 0.03），并且从6个月到12个月随访期间自我效能有所提高（P = 0.02）。在这项小样本试点研究中，艾滋病病毒病毒抑制、预约依从性或药物依从性没有显著变化。
尽管感知可用性较低，但CMs的定性反馈和使用模式表明，CMs与感染艾滋病病毒的AYA之间的直接信息传递以及实验室结果和文件（包括电子签名）的及时、远程和安全共享可能特别有用，并且在支持护理协调以及提高患者自我效能和生活质量方面具有潜在价值。
ClinicalTrials.gov NCT03758066；https://clinicaltrials.gov/ct2/show/NCT03758066 。
