Epidemiology of Clinical Retention Among HIV-Infected Persons in North America

北美 HIV 感染者临床保留的流行病学

• 批准号: 8540794
• 负责人: Peter F Rebeiro
• 金额: $ 4.22万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8540794
• 关键词: AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Advocate; Aftercare; American; Appointment; Benchmarking; CD4 Lymphocyte Count; Calendar; Canada; Caring; Characteristics; Clinic; Clinical; Code; Collaborations; Data; Data Sources; Detection; Disease Outcome; Disease Progression; Effectiveness; Geographic Factor; HIV; HIV-1; Health; Health Policy; Heterogeneity; Immune; Incidence; Individual; Institute of Medicine (U.S.); Intervention; Laboratories; Letters; Life; Measures; Methods; Minority; Modeling; Monitor; North America; Outcome; Patient Appointment; Patients; Pattern; Patterns of Care; Persons; Policy Maker; Population; Public Health; Recommendation; Recording of previous events; Research; Research Design; Resources; Risk; Scanning; Site; Substance abuse problem; Telephone; Testing; Text; Time; Treatment outcome; United States; Viral Load result; base; clinical care; clinical epidemiology; cohort; federal policy; improved; injection drug use; interest; longitudinal analysis; male; multilevel analysis; novel strategies; public health relevance; statistics; transmission process; trend

DESCRIPTION (provided by applicant): Retention in clinical HIV care has been widely recognized as a key component in improving HIV disease outcomes in individuals and decreasing HIV transmission in populations. Measures of retention in clinical care have varied depending on the available data and the population under study, and various demographic, clinical, and environmental characteristics have been observed influencing patterns of care over time. Recently, the National HIV/AIDS Strategy (NHAS) for the United States advocated improvement in clinical retention rates and the Institute of Medicine outlined measures for assessing both the NHAS and benchmarks in the Affordable Care Act. This research therefore seeks to quantify clinical, sociodemographic, and geographic patterns and correlates of retention in care among HIV-infected persons in the United States (US) and Canada, with a particular focus on individuals with a history of injection drug use (IDU). The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) provides a rich data source that has been endorsed by the Institute of Medicine as an important resource capable of monitoring patterns of care among persons living with HIV/AIDS in the United States and assessing progress in the NHAS. Aim 1 will quantify the concordance of laboratory measures (used as surrogates for direct measures of clinical encounters) with actual clinical encounters between 2000 and 2010. Because laboratory measures are widely used as indicators of access to clinical care, this analysis will be of significant importance and has not been previously addressed. Aim 2 will identify the effectiveness of applied interventions to improve clinical retention among HIV-infected individuals in clinical care in North America over the first decade of the 2000s. Aim 3 will identify factors associated with suboptimal retention in care, between 2000 and 2010: demographic and clinical characteristics after adjusting for time-varying confounding by immune status and substance abuse using causal inference modeling, and geographic characteristics using spatial statistics. Secondary analyses will be performed in each aim to assess the patterns and correlates of care specific to HIV-infected individuals with a history of injection drug use, noted in the NHAS and elsewhere as a population of particular interest in addressing HIV treatment and outcome disparities and effectively implementing novel strategies for reducing HIV transmission.

描述（由申请人提供）：临床艾滋病毒护理的保留已被广泛认为是改善个人艾滋病毒疾病结果和减少艾滋病毒在人群中传播的关键组成部分。临床护理保留的衡量标准因可用数据和所研究的人群而异，并且观察到各种人口、临床和环境特征随着时间的推移影响护理模式。最近，美国国家艾滋病毒/艾滋病战略 (NHAS) 提倡提高临床保留率，医学研究所概述了评估 NHAS 和《平价医疗法案》基准的措施。 因此，本研究旨在量化美国和加拿大 HIV 感染者的临床、社会人口和地理模式以及保留护理的相关性，特别关注有注射吸毒 (IDU) 史的个人。北美艾滋病队列研究与设计合作组织 (NA-ACCORD) 提供了丰富的数据源，该数据源已被医学研究所认可为能够监测美国艾滋病毒/艾滋病患者护理模式的重要资源并评估 NHAS 的进展。 目标 1 将量化 2000 年至 2010 年间实验室测量（用作临床直接测量的替代指标）与实际临床测量的一致性。由于实验室测量被广泛用作获得临床护理的指标，因此该分析具有重要意义并且之前没有被解决过。 目标 2 将确定应用干预措施的有效性，以提高 2000 年代头十年北美临床护理中 HIV 感染者的临床保留率。 目标 3 将确定 2000 年至 2010 年间与次优护理保留相关的因素：使用因果推理模型调整免疫状态和药物滥用造成的时变混杂因素后的人口和临床特征，以及使用空间统计的地理特征。 将对每个目标进行二次分析，以评估有注射吸毒史的艾滋病毒感染者的护理模式和相关性，NHAS 和其他地方指出，这些人是对解决艾滋病毒治疗和结果差异特别感兴趣的人群，有效实施减少艾滋病毒传播的新战略。