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  • Periodic Reporting for period 2 - EmERGE (Evaluating mHealth technology in HIV to improve Empowerment and healthcare utilisation: Research and innovation to Generate Evidence for personalised care)

EmERGE Report Summary

Project ID: 643736
Funded under: H2020-EU.3.1.4.

Periodic Reporting for period 2 - EmERGE (Evaluating mHealth technology in HIV to improve Empowerment and healthcare utilisation: Research and innovation to Generate Evidence for personalised care)

Reporting period: 2016-05-01 to 2017-10-31

Summary of the context and overall objectives of the project

With the advent of effective antiretroviral therapy many people are living longer, healthier lives with HIV and are keen to better understand the impact of HIV on their lives and monitor their own health. Concurrently, clinic cohorts continue to increase and populations are ageing with associated co-morbidities and complexities, leading to a need for improved coordination within multi-disciplinary teams and more efficient communication between patients and health care providers.
The EmERGE project aims to reduce face-to-face appointments whilst maintaining quality of care, thereby addressing the desire of individuals to reduce the impact of HIV on their lives and the need to develop a new model of health care provision. The project has developed an mHealth platform which has been successfully integrated with five different clinic ICT systems providing users with a mobile device application which interfaces securely to give remote access for people living with HIV (PLWH) to their relevant medical data. This app is distinctive in the high degree of direct community group involvement in its development.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

The project undertook a detailed background assessment and situational analysis to understand how people living with HIV are followed up in the five participating clinics.
This included an assessment of clinical pathways; ICT infrastructure and security requirements; information governance; and ethical-legal frameworks at each of the clinical sites.
This information was used to develop the application and also for the economic and socio-technical evaluations. A series of ‘co-design’ workshops and interviews were carried out in collaboration with local community groups with PLWH and clinicians to gather their views on the design and the components.
The responses to the consultation for the app were very constructive, informative, and on the whole positive. The primary concerns raised were related to the security of the app and the reduction in personal contact with their consultant. Another clear message was that the app needed to look innocuous.
Systematic reviews of patient empowerment and quality of life measures in HIV have been carried out to determine the best method for evaluating these parameters.
To fully evaluate the potential of this technology, it is being implemented at five different clinics throughout Europe. Currently the project has already enrolled over 700 participants each of whom will be monitored for at least 12 months during which data will be collected on empowerment, health economics, clinical outcomes, patient related outcomes and quality of life.
EmERGE is also evaluating the commercial potential of the platform. To achieve this, the consortium is considering potential markets, the quality aspects of the mHealth platform from a multi-stakeholder perspective (including national and regional factors), the relative importance and ranking of features and benefits and the competitive mHealth landscape. These analyses are informing the development of the product offering both within HIV as well as the potential for applying the technology to patient monitoring for other diseases.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The EmERGE project will take HIV care, mHealth in HIV and the evaluation of mHealth platforms beyond the current state-of-the-art. Proportions of stable PLWH in HIV clinic cohorts will be managed remotely for most of the year and assessed as to whether there is a reduction in the standard of their care.
Within EmERGE adaptability of the mHealth platform to five clinical settings will be shown. The learning from the integration and implementation at different sites will be captured and used to inform a standardized process for approvals and integration at new sites. Barriers to implementation will be explored as part of the sociotechnical evaluation of this project and will be used to optimize the rate of success at new sites. The model of patient care within EmERGE offers choice with patients at the centre of their own care. PLWH are able to choose with whom they share information empowering them to engage with and make decisions about their care. The detailed health economics assessment performed during this study, will be used to understand the impact of such a model on resources at clinical sites. This study has the potential to show true cost minimisation – the core intervention is simple and anticipated uptake is high (based on experience of partners). A detailed understanding of cost as part of the evaluation allows for discussion with commissioners and development of a reimbursable cost structure. An intervention that shows cost and patient benefit in a large validated study will be attractive to providers of HIV healthcare.
The expected potential impacts of the project are:
• Improved self-management of health. It is expected that developing an mHealth platform for PLWH will lead to greater empowerment and involvement of PLWH in their own care. This will be measured by questionnaire before and after the implementation of the mHealth platform.
• Improved linkage to care and doctor/HCP-patient communication and dialogue. It is expected that this technology might overcome barriers such as geographical distance to maintain contact and dialogue without the necessity of traveling.
• Improved cost-effectiveness of HIV healthcare. The cost and cost-effectiveness of the mHealth platform will be evaluated. If deemed as effective as anticipated this approach can then be implemented in other centres treating HIV patients and potentially also applied to other areas of healthcare, especially for the management of people living with chronic, non-communicable diseases.
• Strengthened evidence to inform policymakers. EmERGE will provide real world evidence to inform the development policies, medical guidelines, legal frameworks, medical standards etc. in HIV care and the use of mHealth technologies.

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