HIV Patients’ Tracer for Clinical Assistance and Research during the COVID-19 Epidemic (INTERFACE): A Paradigm for Chronic Conditions

Aristodemos Pnevmatikakis,Stathis Kanavos,Enrica Tamburrini,Roberto Cauda,Alfredo Cesario,Konstantina Kostopoulou,Francesco Vladimiro Segala,Vincenzo Valentini,Sofoklis Kyriazakos,Antonella Cingolani,Giulia Micheli,Cristina Seguiti,Alice Luraschi,Chiara Iacomini,Silvia Lamonica,Stefano Patarnello

doi:10.3390/info13020076

Abstract

The health emergency linked to the SARS-CoV-2 pandemic has highlighted problems in the health management of chronic patients due to their risk of infection, suggesting the need of new methods to monitor patients. People living with HIV/AIDS (PLWHA) represent a paradigm of chronic patients where an e-health-based remote monitoring could have a significant impact in maintaining an adequate standard of care. The key objective of the study is to provide both an efficient operating model to “follow” the patient, capture the evolution of their disease, and establish proximity and relief through a remote collaborative model. These dimensions are collected through a dedicated mobile application that triggers questionnaires on the basis of decision-making algorithms, tagging patients and sending alerts to staff in order to tailor interventions. All outcomes and alerts are monitored and processed through an innovative e-Clinical platform. The processing of the collected data aims into learning and evaluating predictive models for the possible upcoming alerts on the basis of past data, using machine learning algorithms. The models will be clinically validated as the study collects more data, and, if successful, the resulting multidimensional vector of past attributes will act as a digital composite biomarker capable of predicting HIV-related alerts. Design: All PLWH > 18 sears old and stable disease followed at the outpatient services of a university hospital (n = 1500) will be enrolled in the interventional study. The study is ongoing, and patients are currently being recruited. Preliminary results are yielding monthly data to facilitate learning of predictive models for the alerts of interest. Such models are learnt for one or two months of history of the questionnaire data. In this manuscript, the protocol—including the rationale, detailed technical aspects underlying the study, and some preliminary results—are described. Conclusions: The management of HIV-infected patients in the pandemic era represents a challenge for future patient management beyond the pandemic period. The application of artificial intelligence and machine learning systems as described in this study could enable remote patient management that takes into account the real needs of the patient and the monitoring of the most relevant aspects of PLWH management today.

Highlights

People living with HIV infection (PLWH), those with immunodeficiency and immune dysregulation, may be at increased risk of morbidity and mortality during SARS-CoV-2 infection [1]
The results obtained by the entire care system dedicated to the treatment of PLWH risk being compromised by the impact of COVID-19 on the National Health Service, and in particular on the infectious diseases structures, which are central to the strategy of intervention and control of the new pandemic
The COVID-19 pandemic is having a deleterious impact on the physical and, above all, mental health of the chronic population and on the HIV-infected population [38], and the identification of tools capable of identifying physical and mental health problems and producing interventions tailored to the specific needs of the patient represents a significant improvement in the standard of care for people with HIV, even in the absence of physical access to the reference healthcare facilities

Summary

Introduction

People living with HIV infection (PLWH), those with immunodeficiency and immune dysregulation, may be at increased risk of morbidity and mortality during SARS-CoV-2 infection [1]. In Italy, the impact of the COVID-19 pandemic on National Health Service facilities has primarily involved infectious disease facilities, with potential consequences on HIV diagnosis, treatment, and prevention. The model for the management and control of HIV infection in Italy has been based, since the development of Law No 135/90, on the central role of the infectious diseases’ structures, through an articulation of care services in acute inpatient wards, day hospital structures, dedicated outpatient clinics for the taking charge and treatment, and integrated home care structures. The results obtained by the entire care system dedicated to the treatment of PLWH risk being compromised by the impact of COVID-19 on the National Health Service, and in particular on the infectious diseases structures, which are central to the strategy of intervention and control of the new pandemic. The negative impact may involve both the provision of care in acute wards, in particular for people with newly diagnosed HIV and late presentation (AIDS presenters), as well as outpatient facilities for the care and management of chronic patients with stable HIV infection, with possible losses in follow-up and reduced continuum of care

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