Validation study of mHealth technology in HIV to improve empowerment and healthcare utilisation: research and innovation to generate evidence for personalised care (EmERGE)

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The role of unusual pathogens in prostatitis syndrome

Abstract A total of 1442 patients with symptoms of chronic prostatitis were examined over a 4-year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", Zagreb, Croatia. An infectious aetiology was determined in 1070 (74.2%) patients. In 561 of 1070 (52.4%) patients the inflammatory finding (>10 WBC/hpf) was found in expressed prostatic secretions (EPS) or voided bladder urine (VB 3 ). Normal, <10 WBCs/hpf was found in 362 of 536 (67.5%) patients with symptoms of chronic prostatitis in whom Chlamydia trachomatis was detected in EPS or VB 3 , in 51 of 151 (33.8%) patients with isolated Trichomonas vaginalis and in 40 of 72 (55.6%) patients with isolated Ureaplasma urealyticum. Escherichia coli was the causative pathogen in 95, Enterococcus in 68, Proteus mirabilis in 37, Klebsiella pneumoniae in 16, Streptococcus agalactiae in 19, and Pseudomonas aeruginosa in 3 patients with chronic prostatitis. Other patients had a mixed infection. In patients with chronic bacterial prostatitis (CBP) caused by E. coli, P. mirabilis, K. pneumoniae, E. or S. agalactiae, an inflammatory finding was regularly found in EPS or VB 3

A cross-sectional assessment of frailty, falls and perceptions of ageing in people living with HIV using an mHealth platform

Objective To evaluate frailty, falls and perceptions of ageing among clinically stable individuals with HIV, engaged with remote healthcare delivered via a novel smartphone application. Methods Multi-centre European cross-sectional, questionnaire-based sub-study of EmERGE participants. Frailty was assessed using the five-item FRAIL scale. Present criteria were summed and categorised: 0=robust, 1-2=pre-frail, 3-5=frail. Falls history and EQ-5D-5L quality of life measure were completed. Participants were asked their felt age and personal satisfaction with ageing. Result 1373 participated, mean age 45(±9.8). Frailty was uncommon at 2%. 12.4% fell in the previous year, 58.8% of these recurrently. Mood symptoms and pain were prevalent at 43.3% and 31.8% respectively. Ageing satisfaction was high at 76.4%, with 74.6% feeling younger than their chronological age; mean felt age was 39.3 years. In multivariable analysis mood symptoms and pain were positively associated with frailty, falls and ageing dissatisfaction. An increase in pain severity and mood symptoms were respectively associated with 34% and 63% increased odds of pre-frailty/frailty. An increment in pain symptoms was associated with a 71% increase in odds of falling. Pain was associated with ageing poorly, as were mood symptoms with odds of dissatisfaction increased by 34% per increment in severity. Conclusions Though uncommon, frailty, falls, and ageing dissatisfaction were seen in a younger cohort with medically stable HIV-infection using a remote care model, promoting screening as advocated by European guidelines. These were more common in those with pain or mood symptoms, which should be proactively managed in clinical care, and explored further in future research

Falls and frailty are associated with negative perceived ageing and lower quality of life in people living with HIV using the EmERGE mHealth platform

Background:As we streamline long-term HIV care through novel service models, emerging concerns including age-related issues must be addressed. We aimed to evaluate frailty, falls and perceptions of ageing among stable individuals with HIV engaged with remote healthcare delivered via a novel smartphone application.Method: Cross-sectional, questionnaire-based sub-study of EmERGE participants. Frailty assessment used the FRAIL scale, a five-item screening tool. Present criteria were summed and categorised: 0=robust, 1–2=pre-frail, 3–5 frail. Falls history and EQ-5D-5L quality of life tool were completed. Participants were asked: how old they felt & personal satisfaction with ageing.Results: 1373 individuals participated across five European sites. Mean age was 45 (SD 9.8), 93% were male. 1310/1373 (96%) had full frailty data. 74% were robust; 24% pre-frail; and 2% frail. Those exhibiting any frailty characteristics (pre-frail/frail) had greater female representation (p=0.025), higher multimorbidity (p50 (pConclusion:Ageing issues were relatively uncommon, though 12% had fallen and 26% had at least one marker of frailty. Falls and frailty were interrelated and associated with multimorbidity, functional problems, and poorer perceptions of health and ageing. Identifying and tackling ageing concerns should be retained within any mHealth delivered care.</p

Efficiency of the EmERGE pathway of care in five European HIV centres

Objective We aimed to calculate the efficiency of the EmERGE Pathway of Care in five European HIV clinics, developed and implemented for medically stable people living with HIV. Methods Participants were followed up for 1 year before and after implementation of EmERGE, between April 2016 and October 2019. Micro-costing studies were performed in the outpatient services of the clinics. Unit costs for outpatient services were calculated in national currencies and converted to US$2018 OECD purchasing parity prices to enable between clinic comparisons in terms of outcomes and costs. Unit costs were linked to the mean use of services for medically stable people living with HIV, before and after implementation of EmERGE. Primary outcome measures were CD4 count and viral load; secondary outcomes were patient activation (PAM13) and quality of life (PROQOL-HIV). Out-of-pocket expenditure data were collected. Results There were 2251 participants: 87–93$ purchasing parity prices. Primary and secondary outcome measures of participants did not change during the study. Conclusions EmERGE is acceptable and provided cost savings in different socio-economic settings. Antiretroviral drug costs remain the main cost drivers in medically stable people living with HIV. While antiretroviral drug prices in local currencies did not differ that much between countries, conversion to US$ purchasing parity prices revealed antiretroviral drugs were more expensive in the least wealthy countries. This needs to be taken into consideration when countries negotiate drug prices with pharmaceutical vendors. Greater efficiencies can be anticipated by extending the use of the EmERGE Pathway to people with complex HIV infection or other chronic diseases. Extending such use should be systematically monitored, implementation should be evaluated and funding should be provided to monitor and evaluate future changes in service provision