Test of an intervention to improve retention in HIV care after hospitalization

测试改善住院后艾滋病毒护理保留率的干预措施

• 批准号: 7755322
• 负责人: Thomas P Giordano
• 金额: $ 67.52万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7755322
• 关键词: AIDS/HIV problem; Accident and Emergency department; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Aftercare; Attention; Back; Behavior; Behavioral; CD4 Lymphocyte Count; Caring; Characteristics; Chronic; Clinic; Clinical; Complex; Data; Developed Countries; Developing Countries; Diagnosis; Educational process of instructing; General Hospitals; Goals; HIV; HIV Infections; Health; Health Services; Health care facility; Healthcare Systems; Highly Active Antiretroviral Therapy; Hospitalization; Hospitals; Individual; Infection; Intake; Intervention; Intervention Trial; Knowledge; Length of Stay; Life; Low income; Mediating; Medical; Mentors; Modeling; Morbidity - disease rate; Motivation; Outcome; Outpatients; Patient Care; Patient Discharge; Patients; Pattern; Physicians; Population Heterogeneity; Primary Health Care; Public Hospitals; Race; Randomized Controlled Trials; Recruitment Activity; Research; Self Efficacy; Self Management; Social support; Structure; System; Testing; Time; Trust; Viral Load result; Visit; base; care systems; coping; cost; efficacy testing; health related quality of life; high risk; hospital readmission; improved; knowledge base; mortality; patient oriented; prevent; primary outcome; programs; public health relevance; racial and ethnic disparities; response; secondary outcome; skills; successful intervention; theories; volunteer; AIDS/HIV problem; Accident and Emergency department; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Aftercare; Attention; Back; Behavior; Behavioral; CD4 Lymphocyte Count; Caring; Characteristics; Chronic; Clinic; Clinical; Complex; Data; Developed Countries; Developing Countries; Diagnosis; Educational process of instructing; General Hospitals; Goals; HIV; HIV Infections; Health; Health Services; Health care facility; Healthcare Systems; Highly Active Antiretroviral Therapy; Hospitalization; Hospitals; Individual; Infection; Intake; Intervention; Intervention Trial; Knowledge; Length of Stay; Life; Low income; Mediating; Medical; Mentors; Modeling; Morbidity - disease rate; Motivation; Outcome; Outpatients; Patient Care; Patient Discharge; Patients; Pattern; Physicians; Population Heterogeneity; Primary Health Care; Public Hospitals; Race; Randomized Controlled Trials; Recruitment Activity; Research; Self Efficacy; Self Management; Social support; Structure; System; Testing; Time; Trust; Viral Load result; Visit; base; care systems; coping; cost; efficacy testing; health related quality of life; high risk; hospital readmission; improved; knowledge base; mortality; patient oriented; prevent; primary outcome; programs; public health relevance; racial and ethnic disparities; response; secondary outcome; skills; successful intervention; theories; volunteer

DESCRIPTION (provided by applicant): Poor retention in medical care is one of the primary reasons people die of HIV/AIDS today. Modern HIV treatment has transformed this deadly infection into a treatable chronic condition. There are no proven interventions to better retain people in HIV primary care. Hospitalized patients with HIV infection are at high risk for poor retention in care. A single or dual session intervention is essential for most patients out of care, because any patient who could be recruited into a multi-session intervention could likely be recruited back into primary care. Our team has been researching retention in HIV care for over 7 years. Using the information-motivation-behavioral skills model as a framework, our data indicate that among patients recently diagnosed with HIV infection, access to HIV primary care is affected by critical information gaps regarding the availability of care and treatment, limited motivation related to poor coping strategies and low trust in the healthcare system, and weak behavior skills reflected in low self-efficacy and social support around adherence to HIV care. These factors result in poor ability to navigate the health care system and remain in HIV care. We have developed a structured, theory-based, Patient Mentor Program. The Patient Mentor Program was developed to improve retention into HIV primary care by increasing patient knowledge about HIV and the care system, increasing self-efficacy, and promoting active self-management. In a one- time interaction at the Thomas Street Health Center, volunteer patient mentors greet new patients who are arriving for their intake visit to the clinic, guide them through the intake visit and support them. In our preliminary, quasi-experimental data, 88% of patients who had a patient mentor during that intake visit completed a physician visit within the next 90 days, compared to 78% of patients who did not have a mentor (p<.001). These effects remained significant after adjusting for baseline demographic and clinical characteristics, and persisted into the 90-180 day interval after intake. We will test the efficacy of the TSHC patient mentor intervention in a 5-year randomized, controlled trial in 434 socio-economically and racially diverse HIV-infected patients hospitalized at Ben Taub General Hospital. We hypothesize that the intervention will meaningfully increase retention in HIV primary care after discharge compared to an attention control. Our Specific Aims are: 1) To test the efficacy of the patient mentor intervention on retention in HIV primary care after hospital discharge; 2) To test the efficacy of a patient mentor intervention on secondary outcomes that include health services use, health-related quality of life, and clinical outcomes; 3) To determine the mediating factors associated with response to the intervention, and the individual and system facilitators and barriers to retention in HIV primary care. This study addresses one of the most important challenges in HIV care today, i.e., expanding modern HIV treatment to all those in need, and may also impact race-based disparities in the health of people with HIV infection. PUBLIC HEALTH RELEVANCE: Poor retention in medical care is one of the primary reason people die of HIV/AIDS today. We have developed a structured, theory-based, Patient Mentor Program to improve retention into HIV primary care. We will test the efficacy of this patient mentor intervention in a 5-year randomized, controlled trial in more than 400 socio-economically and racially diverse HIV-infected patients hospitalized at Ben Taub General Hospital.

描述（由申请人提供）：医疗保健保留率不佳是人们今天死于艾滋病毒/艾滋病的主要原因之一。现代艾滋病毒治疗已将这种致命的感染转化为可治疗的慢性疾病。没有可靠的干预措施可以更好地保留艾滋病毒初级保健。艾滋病毒感染的住院治疗患者的护理保留率不佳。单一或双重课程干预对于大多数失业患者来说都是必不可少的，因为任何可以招募到多课程干预措施的患者都可以招募到初级保健中。我们的团队已经研究了7年以上的艾滋病毒护理保留率。我们的数据将信息动机 - 行为技能模型作为框架，我们的数据表明，在最近被诊断出患有HIV感染的患者中，获得HIV初级保健的机会受到有关护理和治疗的可用性的关键信息差距，与不良的应对策略相关的有限动机以及对医疗保健系统的低信任和较低的信任，以及在自我效能下较低的自我效能研究中反映了HIV Artiv Ardiv Ardiv Ardiv Ardiv Ardiv。这些因素导致驾驶医疗保健系统并保持艾滋病毒护理的能力不佳。我们已经开发了一个基于理论的，患者导师计划。通过提高患者对艾滋病毒和护理系统的知识，提高自我效能感并促进积极的自我管理，开发了患者导师计划，以提高患者对艾滋病毒初级保健的保留。在托马斯街健康中心的一次时间互动中，志愿者的患者导师打招呼的新患者迎接了他们摄入诊所的摄入，并指导他们进行摄入访问并支持他们。在我们的初步，准实验数据中，有88％的患者导师在此期间接受患者导师的患者在接下来的90天内完成了医生的访问，而没有良师的患者中有78％（p <.001）。在调整基线人口统计学和临床​​特征后，这些效果仍然显着，并在摄入后持续到90-180天。我们将在434例社会经济和种族多样化的HIV感染患者中，在一项为期5年的随机对照试验中测试TSHC患者导师干预的功效，该试验在Ben Taub综合医院住院。我们假设与注意力控制相比，干预措施将有意义地增加出院后HIV初级保健的保留率。我们的具体目的是：1）测试出院后患者导师干预对艾滋病毒初级保健保留的疗效； 2）测试患者导师干预对包括健康服务使用，与健康相关的生活质量和临床结果在内的次要结果的疗效； 3）确定与干预反应相关的中介因素，以及个人和系统的促进者以及在HIV初级保健中保留的障碍。这项研究解决了当今艾滋病毒护理中最重要的挑战之一，即向所有有需要的人扩大现代艾滋病毒治疗方法，并可能影响基于种族的艾滋病毒感染者的健康差异。公共卫生相关性：医疗保健保留不佳是人们今天死于艾滋病毒/艾滋病的主要原因之一。我们已经开发了一个基于理论的，患者导师计划，以改善艾滋病毒初级保健的保留率。我们将在一项在Ben Taub综合医院住院的400多名社会经济和种族多样性的HIV感染患者中，在一项为期5年的随机对照试验中测试该患者导师干预的功效。