2003 Grant Application: "Adherence to Therapy in HIV-Infected Children"

TITLE OF PROJECT: Webcam DOT (Directly Observed Therapy)

BACKGROUND OF PROGRAM/INSTITUTION

Major Medical Institution has a Pediatric HIV/AIDS Program that provides comprehensive health and social services to infants, children, adolescents, women, and families infected and affected by HIV/AIDS. Our mission is to assure the best quality of life for children and families living with HIV by providing state-of-the-art medical care in the context of sensitive and compassionate support services, and the age and stage of disease of individual client’s receiving care.

The Pediatric HIV/AIDS Program began in 1985 when the first child with HIV infection was identified and cared for in the Pediatric Primary Care Program of the Children’s Center. The extensive and complex medical, social, and emotional needs of this child and her family crystallized the need for a comprehensive, coordinated program for children and families affected by HIV/AIDS in the Baltimore area. Under the thoughtful direction of Dr. (name removed for privacy), the program has grown in size and expanded in scope over the past 15 years in response to the needs of our community’s children and their families.

The clinical care portion of the program provides intensive services and support using the primary health care and case management models of service provision. Medical and social needs are assessed and met along the continuum of care ranging from in-patient tertiary care through outpatient ambulatory care. Home and school based services are provided on as needed basis. The program has cared for over 900 children since 1985. Currently we serve 277 youth.

The Children’s Center HIV Program also facilitates patient oriented research and is a member of the Pediatric AIDS Clinical Trials Group (PACTG) and the Adolescent Trials Network (ATN). Faculty and staff present research findings and clinical experiences in peer reviewed journals and at local, national, and international conferences. In addition, our team has produced several videos of relevance to treatment providers and clients.

Current funding for our major program components is provided by: Associated Black Charities, Pediatric AIDS Foundation and, AIDS Administration (HRSA), and the CDC PHIPP Social Network Demonstration Project. In addition, a number of other philanthropic agencies have provided funding for several additional program components including: Children and Families Affected by AIDS (CAAF), WAWA Corporation and, the Elizabeth Glazer Foundation.

REQUEST FOR FUNDING

 Statement of need and the expected impact of the proposed work:

Medication adherence problems are of great concern and challenge to health care providers who treat youth with chronic illness. Recently published studies highlight the seriousness and urgency of adherence problems for HIV infected youth (1). For example, in a retrospective analysis of the medical charts of a small sample of HIV-infected adolescents in Chicago, aged 13-21, Martinez et al. (2) found that 72% (n=25) were non-adherent, and that 67% of the study participants reported missing doses. Blezer and colleagues (3) reported that only 61% of a clinic-based sample of 31 adolescents reported at least 90% compliance with their medication regimens in the previous 90 days. Among the 161 adolescents followed as a part of the REACH cohort, 41% reported full adherence (4).

Researchers and clinicians have put forth a lot of effort to understand the correlates of adherence problems (5). Unfortunately, while we have learned a lot about how to identify barriers to adherence, we know much less about how to provide long-term treatment and on-going assessment of medication consumption habits and problems.

The Pediatric and Adolescent HIV program is actively involved in addressing the challenges of maintaining medication adherence to HAART treatment. In fact, all treatment team members are engaged in this effort and a part of each clinic visit is devoted to this important issue. A number of innovative clinical programs have been developed to support HIV infected youth in obtaining and maintaining the skills and motivation necessary to achieve the positive health benefits associated with adherence to HAART (e.g. Camp Kokua, Medical Student Buddy Program, Adolescent Leadership Training Program, Kids Who Know Support Group, Adolescents Who Know Support Group).

We have come to recognize that a major barrier to adherence for many HIV infected youth is the lack of consistent and appropriate care-giver prompting and support for establishing and maintaining a consistent medication administration routine. Our observations of the importance of a stable and supportive living situation are echoed in a recently published study conducted by the Center for Disease Control (6). Although we routinely use a variety of interventions to increase care-giver participation in medication administration regimens, for some youth, there simply is no consistently available support within their home to take their medications.

This project will involve the development and piloting of a web-based solution to provide medication adherence support to adolescents with HIV. The attached schematic illustrates the webcam communication configuration that will allow 5 youth to teleconference with a Hospital staff member. Note that the configuration allows for Hospital staff to use a laptop system for offsite monitoring or a hospital-based system for on-site work. Although the technology for this type of application does not currently exist, we have secured commitments from very capable programmers to assist in the development of the needed software, website programming, computer configuration and set-up.

Once the communication software has been written and the computers and web-cams are installed, patients and a staff member (e.g. RN, Psychologist, Social Worker, or Physician) will connect to a secure internet site (to be hosted by 321cam.com) at prearranged times to take medication and provide social support to one another. The intervention is aimed at providing a cost-effective approach for medical providers to achieve directly observed therapy. Once developed, this protocol could be used in the treatment of youth with other chronic medical conditions.

To develop a web-based solution that can be used to optimize adherence to medical services and prescribed medication regimens in youth with HIV.

To secure additional funding to allow for further development and assessment of this adherence enhancement intervention.

 Strength and potential problems that could be associated with this project: This proposal describes a novel approach to provide support for youth with medication adherence problems. We have spoken with several youth who have medication adherence problems about this project and each was excited about the possibility of working with staff to get this communication tool working. Potential problems could include: (1) difficulties in programming the web cams to be able to "cross-talk" with one another, (2) difficulties finding staff who are willing to work with youth during medication administration times (i.e. generally 7 am & 7 pm for High School students in (removed for privacy)  City and (removed for privacy) County).

Plans for assessing the effect of the grant & plans for maintaining funding after the grant expires: The web solution will be piloted with 5 youth. The impact of the intervention on medication adherence will be assessed through use of prescription refills, health care provider report, and through comparison of disease progression indices prior to and after youth participation in the program. In addition, staff and patients will be asked to complete a Satisfaction Questionnaire (to be developed) to assess which aspects of the intervention were felt to be helpful and which were perceived as burdensome or not useful.

They are located in Faribault MN (45 minutes south of the Twin Cities).  The campus sits on about twenty or so acres and consists of ten buildings. 

The network extends to all buildings.  We are running at 100mb with a combination of hubs and switches providing connectivity.  Internet connectivity is via a full T1 line.  There are about 175 workstations on the network.  Each classroom is equipped with at least one networked workstation and each of the 3 academic buildings has a ten computer lab as well as a ten computer lab in the school library.

The 2 dorm buildings are also equipped with workstation study/leisure areas (mini-lab settings).  The boys dorm has three two story wings with two computers on each floor of each wing - a total of 12.  The girls dorm has two floors and two wings with 3 computers per floor per wing - again a total of 12.  The remaining buildings house support services - cafeteria, maintenance, gym, etc.

Initial install of 50 to 60 cams with more to follow as they upgrade to XP.  The total number of cams would probably approach 100 if not a few more than that - some of the workstations are too slow to adequately support WinXP and therefore would never have USB support.

Remote Controlled Webcams: There is a pre-school classroom that could benefit from one, as well as K thru 4th - might be a nice idea to allow parents of young children the ability to view classroom activity.  And each of the four computer labs.  That totals 9.  Including 5 conference rooms too.  14 total... at this point.  I'm sure as they move ahead we might find some additional areas where a remote cam would be an advantage.

Stationary webcams are not really expensive. But they might want 14-30 remote controlled webcams, and these are more expensive. They even might use some wireless ones too.

We would donate our Diamond Software Plan and Services to their academy for a period of 5 years. We would also install the software on many of their computers and also have a training class showing them how to install the broadcaster and also the viewer software.

Stationary webcams are not really expensive. But they might want 14-30 remote controlled webcams, and these are more expensive. They even might use some wireless ones too.

We would need to have some help getting that many webcams purchased, but the install of them and software is something we can handle. I will start looking around for other companies, corporations, and organizations that might be able to help on the purchase of the webcams including asking to be put in contact with the foundations and other local organizations that have donated time and/or materials to the academy.
 

The Ramsey Country Humane Society is another project of ours. Have donated and installed two webcams one for their dogs and one for their cats area. Dog cam is a wireless webcam, and the cats is a remote controlled webcam and is located about 100’ away from the PC.

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321Cam.com is seeking to raise $ 232,000 in its first significant round of funding through the sale of stock in the company to the venture capital community at $ 10 per share. The minimum investment is $ 50,000, unless waived by the company. The company anticipates a second round of funding during May 2003 in which it expects to raise between $ 110,000. So far all investments have been by Steve Cook and it was all in cash (no loans or debt). For more information on investment opportunities with 321Cam.com, or to receive a copy of the company’s Subscription Agreement, contact:

Formal business plan and references are available upon request to interested parties.

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