Archive for the ‘mobile technology’ Category

HIV/AIDS in the US: the importance of local perspectives

Monday, November 13th, 2017

Some recent studies, in STI and other journals, have sought to demonstrate the importance of spatial location as a determinant of STI prevalence in its own right (Haley & Cooper (STI); ‘Scoping Location’ (STI/blogs))). On the face of it, Brawner & Schensul appear to share this aim, in their comparative neighbourhood-based case study of multilevel factors affecting HIV transmission in four Philadelphia census-tracts. However, the most striking outcome reported in this paper (see also Brawner & Guthrie) are findings concerning the relationship of race and sex to the mode of HIV transmission.

Lacking the resources that would be required to study the entirety of Philadelphia, the authors try to cash out the influence of spatial location by restricting themselves to four census tracts, chosen on the basis of their representation of extremes of racial composition and HIV prevalence: a low-prevalence black area, a high-prevalence black area, a low-prevalence white area, and a high-prevalence white area. The variables of interest are: first, race and gender; second, income and insurance status. This allows the researchers to profile, in contrasting terms, the average HIV/AIDS-infected individual in the four areas.

As it turns out, the average HIV/AIDS-infected individual in the low-prevalence black area will be a poor, Medicaid/uninsured, black women who has been infected heterosexually; the average individual in the high-prevalence black area will be a poor, Medicaid/uninsured, black man, who has been infected heterosexually; in the low-prevalence white area, they will be a poor, Medicaid/uninsured white man who has been infected homosexually; while in the high-prevalence white area, they will be a relatively better-off, insured, man who has been infected homosexually.

As regards the stated aim of the study, the importance of location as a factor in its own right remains unclear. As in the case of Haley & Cooper (STI), location tends to dissolve on closer analysis into a ‘proxy’ for various other factors (e.g. race and prevalence). What does emerge very clearly, by contrast, is the importance of being able to take a ‘local’, as opposed to a national or global, perspective of the HIV/AIDS epidemic. As is well known, the vulnerability to HIV/AIDS of black MSM, as a group, is particularly serious (see ‘What is the potential of ‘treatment as prevention” (STI/blogs)). So, at a national level, a concentration on reducing incidence amongst MSM populations – and black MSM, in particular – makes a lot of sense. Yet what Brawner & Schensul bring home in this paper is, in certain areas, the importance of HIV-AIDS infected populations with a very different cultural and social profile – e.g. people who are black, heterosexual, sometimes women, and, more often than not, on Medicaid/without insurance.

 

How Mobile Technology Can Lead to Improved Care of STIs – by Julie Potyraj

Tuesday, August 16th, 2016

Blog by Julie Potyraj, Community Manager, Milken Institute School of Public Health at The George Washington University

e: jpotyraj@publichealthonline.gwu.edu

As we move into an era where our phones do everything from lowering the temperature in our homes to arranging a ride, it comes as no surprise that these devices also offer a new way to meet and engage with potential sexual partners. Along with the rise in popularity of dating apps, there has been an increase the incidence of sexually transmitted infections. In 2014 the CDC received the highest number of reports in history for chlamydia, syphilis, and gonorrhea in the United States. The challenge is to figure out a way to use technology to safeguard our sexual health in addition to meeting new partners.

In an effort to encourage online daters to get tested, a study published in Sexual Health posted advertisements for free HIV test kits on the dating website Grindr. In exchange for providing personal information about their health status and behaviors, participants received a free test kit. Not only did this intervention encourage HIV testing, but the study also showed an increase in the number of young men seeking treatment. Even a few of the volunteers who helped with the study became aware of their statuses.

The Grindr study shows that the privacy and comforts of home testing can be a desirable alternative to visiting a doctors’ office. Providing this alternative could potentially increase the number of people seeking testing for STIs. Improved testing technology used in tandem with the convenience and range of a mobile device introduces the opportunity to connect huge numbers of people with diagnostic interventions. The more people who get tested, the more data there is available. If this trend continues, we can anticipate an incredible expansion in electronic reporting, STI surveillance, and the use of this data in health informatics.

Mobile technology contributes to the collection of big data, which is defined as complex data sets that are so large that they cannot be evaluated by traditional data management tools. With better surveillance of STIs, medical providers can reach and identify commonly overlooked demographics by tracking trends to improve diagnostic care, interventions, patient outcomes, and cost of care.

More widely available data about STI outbreaks and incidence rates could help health care providers to make more informed medical decisions. For example, a care provider who identifies chlamydia from a patient’s urine could use big data to inform her decision about what type of antibiotic to prescribe. She may find there is an increasing incidence of azithromycin-resistant chlamydia in her city or state. Her awareness of this emerging trend would lead her to prescribe her patient with doxycycline instead; providing better medical care through informed treatment decisions.

The use of mobile technology can broaden epidemiologic surveillance and trend analysis of STI infections, offering knowledge to care providers that is otherwise unobtainable. More people using STI diagnostic interventions leads to the more people being tested and in turn better access to STI statistics. Mobile technologies, and health interventions that make use of them, can contribute to the collection of timely, relevant data. The analysis and interpretation of this data offers the possibility of improving health care quality and outcomes for patients.

Julie Potyraj