Bay Area Reporter - November 19, 2009
Seth Hemmelgarn, s.hemmelgarn@ebar.com

Both studies are funded through the federal American Recovery and Reinvestment Act, otherwise known as the stimulus bill.

One study will look at using mobile phone text messages to help HIV patients' adherence to pill-taking regimens. Using information from the patients' electronic records, they'll receive text alerts reminding them to take their medications.

Dr. James S. Kahn, professor of clinical medicine at the UCSF Positive Health Program at San Francisco General Hospital, said that researchers are establishing the information technology planning for the project.

More than 250 people from the Positive Health Program will participate, he said.

"We're hoping that our complicated patients, who have complex treatment regimens, will get improved care," said Kahn.

He said that if the researchers can show that, then "these kinds of applications will be critically important to all our patients."

Kahn said that the technology could also be used to help people with other health conditions such as diabetes.

Kahn said that the texting method has been done "but not for our patients, who are on the opposite side of the digital divide and who don't have as many resources as other persons receiving health care."

"We'll know whether this is useful or not within two years," said Kahn.

San Francisco resident Felicia Elizondo, 63, said that she has a calendar next to her refrigerator where she marks when she's taken her pills, but "sometimes I do forget, because I'm really busy."

Elizondo has been HIV-positive for 22 years and has been taking medications for the last 10. She said the text alerts "would be like an extended member of the family" reminding people to take their medications. Elizondo is not a Positive Health Program patient.

The other study will test the feasibility and acceptability of a web-based strategy aimed at cutting drug and alcohol use and accompanying HIV risk behaviors. The strategy, called SBIRT, consists of screening for drug and alcohol use, a brief intervention, and referral to treatment.

The strategy, which also seeks to improve antiretroviral HIV-positive patients' medication adherence, has been shown to be effective in many populations in reducing drug and alcohol use, but it hasn't been used in an HIV primary care setting.

The project will compare SBIRT delivered through a self-administered, 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," Carol Dawson-Rose, Ph.D., MSN, RN, associate professor of nursing at the UCSF Center for AIDS Prevention Studies, said in a statement.

"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."

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 and 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.

In other HIV news

Peggy Dolcini, an associate professor in the Department of Public Health at Oregon State University, has been awarded a $1.3 million grant to conduct HIV and STD-prevention research among inner-city African American teens in San Francisco and Chicago. The National Institute of Child Health and Human Development is funding the research.

Researcher Cherrie Boyer, Ph.D., of UCSF is among the co-investigators of the study, according to an Oregon State University news release

African American youth are one of the highest risk groups in the United States. Dolcini's new study builds on prior research she's done, which has documented the influence of peer groups and other social factors on adolescents' risk behavior.

In an e-mail to the Bay Area Reporter , Dolcini wrote that the study builds on the research that's been conducted in the Bayview-Hunters Point, Potrero Hill, Sunnydale, and Western Addition neighborhoods of San Francisco.

"The focus of this work has been primarily on heterosexual youth," wrote Dolcini.

The three-year study will examine sex and gender roles in the context of African American urban neighborhoods.

"We want to build a better understanding of what factors contribute to adolescents' ideas about being a young African American man or woman," said Dolcini in the news release. "With a better understanding of these issues, we can develop programs that are tailored to the needs of these youth."

Dolcini said that data collection will start in 2010.
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