Identifying, testing, treating and retaining persons with newly diagnosed HIV infection represents a substantial opportunity to improve the health of individuals by linking them into care for a previously unsuspected serious condition and to impact public health by influencing risk factors for transmission. When patients with newly identified HIV infection and with substance use disorders are managed in a safety net setting, their already complex healthcare needs are further compounded by high rates of health illiteracy and a lack of access to health information. Internet enabled personal health records (PHRs) provide patients with access to health information, health technology and closer connections to their health systems. Cell phones are another tool for improving connections between patients and their care centers (and for information exchange). Although internet and cellular connections are complementary technologies, cell phones are more accessible to many disadvantaged patients than the internet. Thus cellular connections and the tools available on these networks may prove critically important to improve healthcare for patients in the safety net setting and could play an important role in linking these patients to the health care system. Internet and cellular technologies present new and sustainable opportunities to help AIDS/HIV patients stay in care, especially individuals with co-occurring substance use disorders, with the ultimate goal of improving access to information and providing tools for self-management of their healthcare. In this application we propose an innovation to teach and train newly diagnosed HIV infected individuals to utilize deployed internet and cellular technologies and develop novel applications to assist with linkages to care and improve treatment outcomes. In this project we will determine the impact from patient training in the use of internet and cellular technologies (designed with patient input and built to assist patients self-manage their health) on referrals and follow through with appointments, retention in care and the initiation and sustaining of appropriate antiretroviral treatment. We will utilize developed and deployed technologies that have not been applied previously to the newly identified HIV infected population to determine if internet and cellular technologies improves important biologic, social and health-related outcomes. The target population, newly identified persons with HIV infection receiving care in a safety net setting, meets an additional critical need: to understand how patients in the safety net access and utilize technology tools. Our findings may identify methods to narrow the growing information technology (IT) gap in this country and reduce exclusion of these patients from health-related IT initiatives. Our results will likely inform implementation of Web-based and cellular innovations in other venues. We hypothesize that patients trained and educated to use Web-based and cellular platforms will demonstrate improvements in self-management of healthcare needs, retention in care, and medication adherence, collectively contributing to improved health outcomes.

Public Health Relevance

HIV/AIDS is a serious illness and timely identification of persons with HIV infection followed by the initiation of effective antiretroviral treatment prolongs life and is cost effective. Identifying, testing, treating and retaining persons with newly diagnosed HIV infection represents a substantial opportunity to improve the health of individuals by linking them into care for an unsuspected serious condition, and perhaps influence risk factors that contribute to viral spread within a community. When patients with newly identified HIV infection and with substance use disorders are managed in a safety net setting, their already complex healthcare needs are further compounded by high rates of health illiteracy and a lack of access to health information. Despite the multiple approaches to treatment there is ample evidence that persons with experiencing health disparities (African-Americans, women and injection drug users) may have poorer access to rapid diagnosis, treatment and problematic adherence and thus have greater HIV health complications. Although internet and cellular connections are complementary technologies, among many disadvantaged patients cell phones are more commonly used than then the internet. Thus cellular connections and the tools available on these networks may prove critically important to improve healthcare for patients in the safety net setting and will be play an important role to link these patients to their health care system. We have implemented the Chronic Care Model in our clinic and placed our emphasis on effective clinical information systems and have shown that the personal health records (PHRs) are a platform for patients to access their clinical information, to communicate with their clinicians and to respond to survey questions. In this application we propose to teach and train newly diagnosed HIV infected individuals to utilize internet and cellular technologies to assist linkages to care and improve outcomes of care. Our findings may identify methods to narrow the growing information technology (IT) gap and reduce exclusion of these patients from health-related IT initiatives.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA032057-02
Application #
8302228
Study Section
Special Emphasis Panel (ZDA1-NXR-B (06))
Program Officer
Aklin, Will
Project Start
2011-07-15
Project End
2016-04-30
Budget Start
2012-05-01
Budget End
2013-04-30
Support Year
2
Fiscal Year
2012
Total Cost
$547,098
Indirect Cost
$107,515
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143