HIV Care Utilization: A theory-based approach to retention in care

HIV 护理利用：一种基于理论的保留护理方法

基本信息

批准号：
8209718
负责人：
Laramie Rae Smith
金额：
$ 3.4万
依托单位：
UNIVERSITY OF CONNECTICUT STORRS
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-01-01 至 2012-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8209718
关键词：
Acquired Immunodeficiency Syndrome Address Adherence Aftercare Anti-Retroviral Agents Appointment Area Attention Attitude Behavior Behavior Therapy Behavioral Belief Caring Centers for Disease Control and Prevention (U.S.)Clinic Clinic Visits Communities Development Early Diagnosis Enrollment Epidemiology Equation Evaluation Failure Goals HIV HIV Seropositivity Health Health Status Health behavior Healthcare Healthcare Systems Indium Individual Intervention Life Literature Logistic Regressions Logistics Maintenance Measures Medical Minority Modeling Monitor Motivation Outcome Patients Pharmaceutical Preparations Population Problem Solving Process Protocols documentation Provider Public Health Records Regression Analysis Research Resistance Review Literature Risk Risk Reduction Sampling Schedule Services Social support Testing Time Translating Treatment Failure Viral Viral Load result Work base behavior measurement brief intervention clinical care cohort design effective intervention high risk improved indexing inner city innovation intervention effect men who have sex with men mortality motivational enhancement therapy patient oriented point of care post intervention prevent programs psychologic psychosocial public health relevance skills social success theories therapy design

项目摘要

DESCRIPTION (provided by applicant): Inconsistent use of HIV medical care has been associated with potentially dire outcomes for both the individual HIV positive patient in care and the surrounding community due to increased burden of individual- and community-level viral load. While there have been recent intense efforts to enroll people living with HIV (PLWH) into care and to re-engage PLWH lost to care, less is known about factors influencing sustained maintenance in HIV-care once initiated or re-initiated, despite this group's particular vulnerability to additional complications (such as resistance due to intermittent adherence) and the window of opportunity for clinic- based intervention that they present. The proposed work aims to address this gap in the literature and unmet service-related needs through the development and evaluation of a theory based model of retention in care and a brief targeted intervention to support retention in care for those tenuously engaged. We adapt the well- established the Information-Motivation-Behavioral Skills (IMB) model to retention in HIV medical for use in two studies. This IMB model is used to identify the core psycho-social processes in terms of the types of information, motivation, and behavior skills needed to sustain regular use of HIV medical care over time by identifying potentially modifiable deficits in these psychological processes that can be used to inform retention- related intervention strategies. In Study 1 we will use a cross-sectional IMB-based measure of retention in care to test the model and identify the critical levels of information, motivation, and behavioral skills related to retention in care within an inner-city clinic sample. Specifically, our first aim is to test an Information- Motivation- Behavioral Skills Model of retention in HIV medical care in an inner-city clinic population. Study 2 will pilot an intensive single-session motivational-interviewing based intervention that uses an IMB- model based screener to identify individual model-based barriers to retention in care to tailor the patient- centered discussion targeting adherence to the next clinic visit specifically for patients who have gapped in HIV care over the last year and a half. This intervention will be evaluated against a time and attention control condition within the same cohort on objective indices of care utilization six months post intervention, as well as on immediate post-intervention changes in information, motivation, and behavioral skills. Thus, our second aim is to design, implement, and evaluate a proof-of-concept clinic-based intervention designed to address core IMB model determinants of retention in care, and promote retention in care in a tenuously engaged inner-city sample. The proposed project will contribute uniquely to this area of inquiry and have practical implications for viable intervention approaches for controlling individual- and community-level viral burden. PUBLIC HEALTH RELEVANCE: The proposed project will test an Information Motivation Behavioral Skill model of retention in HIV medical care and evaluate a brief targeted intervention to promote retention in care via improvements in the core factors identified by this mode, which uniquely contributes to this area of research by providing a comprehensive model of retention that can be easily translated to effective intervention approaches. The pilot of the targeted theory-based intervention has implications for both extending our understanding of effective interventions for retention in care as well as for providing guidance for potential strategies to promote engagement delivered at the point of clinical care. Such efforts to enhance and sustain retention in care are necessary to achieve improved health and significant reductions in viral load critical to individual and public health.

描述（由申请人提供）：由于个体和社区水平的病毒载荷负担增加，对艾滋病毒医疗保健的使用不一致与个人艾滋病毒阳性患者和周围社区的潜在可怕结果有关。尽管最近已经做出了激烈的努力，即让艾滋病毒（PLWH）的人加入护理并重新接触PLWH，但对一旦发起或重新发起的艾滋病毒保健的持续维护的因素却少知道，尽管该集团特别容易受到额外的并发症（例如，由于间歇性依从性而引起的抵制），以及临床介绍的临时介绍。拟议的工作旨在通过开发和评估基于理论的保留在护理中的保留和简短的有针对性的干预措施来支持保留保留护理方面的文献和评估，以解决文献中的这一差距和未满足的服务相关的需求。我们适应了良好的信息动机行为技能（IMB）模型，以保留在HIV Medical中，以在两项研究中使用。该IMB模型用于根据信息，动机和行为技能的类型来确定核心心理社会过程，以通过在这些心理过程中识别可用于保留与保留相关的干预策略的这些潜在可修改的缺陷所需的定期使用。在研究1中，我们将使用基于IMB的基于IMB的保留量测试模型测试模型，并确定与内城市诊所样本中保留的关键信息，动机和行为技能的关键水平。具体而言，我们的第一个目的是测试城市诊所人口中HIV医疗保留的信息动机行为技能模型。研究2将基于基于IMB模型的筛选器来探索基于IMB模型的筛选器的基于密集的单会动机干预措施，以识别基于模型的保留措施以量身定制针对患者以患者为中心的讨论，该讨论针对遵守下一次诊所，专门针对过去一年和一半的艾滋病毒护理中的患者。该干预措施将根据同一队列中的时间和注意力控制条件进行评估，以在干预后六个月以及对信息，动机和行为技能的立即进行干预后的变化。因此，我们的第二个目的是设计，实施和评估旨在解决核心IMB保留率的核心IMB模型决定因素，并在繁重参与的内部城市内部样本中促进保留保留率的基于概念诊所的干预措施。拟议的项目将为这一探究领域提供独特的贡献，并对可行的干预方法具有控制个人和社区级别的病毒负担的实际影响。公共卫生相关性：拟议项目将测试信息动机在艾滋病毒医疗保健中保留的行为行为技能模型，并评估短暂的有针对性的干预措施，通过改进该模式确定的核心因素来促进保留保留，从而通过提供可以轻松地转换为有效干预措施的综合保留模型来为这一研究领域提供独特的贡献。基于靶向理论的干预措施的试点对我们对保留保留的有效干预措施的理解以及为促进在临床护理时提供的参与度提供指导的指导具有意义。为了改善健康和对个人和公共卫生至关重要的病毒负荷的大幅减少，必须进行加强和维持保留的努力。