UCSF HIV researchers have received two NIH grants of $1 million each to study the use of web-based, patient controlled personal health records to improve health and HIV prevention outcomes for HIV positive patients.
Both studies are funded through the federal stimulus bill, The American Recovery and Reinvestment Act.
One study will look at using mobile phone text messages linked to a web-based personal health record to help HIV patients' adherence to pill-taking regimens.
"Patients participating in the study will not only be assisted with taking their HIV medications, but also with medications for conditions like diabetes and hypertension. At least half the patients we see in our clinic have at least one other chronic disease that requires medication to control. Our hypothesis is that using individualized text message reminders linked to personal health records will help patients better succeed in self-management of their multiple health challenges," said James S. Kahn, MD, professor of clinical medicine at the UCSF Positive Health Program at San Francisco General Hospital.
Two methods will be used to assess adherence to medication regimens in this project. Self-report of pill taking is one. A biological marker, measurement of antiviral drug levels in hair, is the other method used. A member of the research team, UCSF assistant professor of medicine Monica Gandhi, MD, MPH, has shown this method to be a better correlate of success in HIV viral suppression during treatment than other variables usually considered.
The other study will test the feasibility and acceptability of a web-based strategy that seeks to reduce drug and alcohol use and accompanying HIV risk behaviors and improve antiretroviral medication adherence by HIV positive patients.
The strategy is called SBIRT and consists of screening for drug and alcohol use, a brief intervention and referral to treatment. It has been shown to be effective in many populations in reducing drug and alcohol use but has never been used in a HIV primary care setting. With several studies showing a relationship between high HIV transmission risk behaviors and drug and alcohol use, effective administration of the SBIRT strategy could also reduce HIV transmission according to the project team.
The project will compare SBIRT delivered through a self-administered and web-based method using patients' electronic health records with SBIRT delivered through a provider-administered protocol during clinic appointments using an electronic health record system.
"We want to see if the SBIRT approach will work in this population and this setting to not only reduce drug and alcohol use but also succeed in reducing HIV transmission associated with substance use. We are hoping to find out whether patients are more open to responding to sensitive topics with a self-administered web-based approach than they are talking directly with their clinician," said Carol Dawson-Rose, PhD, MSN, RN, associate professor of nursing at the UCSF Center for AIDS Prevention Studies.
Both studies use HERO (Health Care Evaluation Record Organizer), a web-based electronic medical record system and research database developed by Kahn and T. Van Nunnery, a programmer/analyst at UCSF, and myHERO. Integrated with HERO, myHERO is a publicly-accessible personal health record enabling patients to access information online from their own medical record. This complete electronic health record system is secure, flexible, extensible, and is exportable to other clinical care venues.
From the first reports of the HIV/AIDS epidemic over 25 years ago, the UCSF Positive Health Program at San Francisco General Hospital has led the world in defining best practices of clinical care in HIV/AIDS medicine.
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