Influence of patient-centered HIV care on retention and viral suppression disparities

以患者为中心的艾滋病毒护理对保留和病毒抑制差异的影响

基本信息

批准号：
10058773
负责人：
MARY JO TREPKA
金额：
$ 26.96万
依托单位：
FLORIDA INTERNATIONAL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-01-29 至 2023-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10058773
关键词：
Accounting Address Administrator Adult Affect African American American Attitude Bayesian Network Buffers Caring Case Management Characteristics Client Clinical Clinical assessments Cohort Studies Communication Communities Community Surveys County Data Enrollment Ensure Epidemic Focus Groups Funding HIV HIV Infections Healthcare Systems Housing Human Immunologic Deficiency Syndromes Incidence Individual Influentials Intervention Interview Knowledge Laboratories Latino Medical Minority Groups Neighborhoods Outcome PF4 Gene Patient Preferences Patient-Centered Care Patients Pharmaceutical Preparations Poverty Prospective cohort study Provider Psychosocial Factor Research Role Self Management Services Site Structure Surveys System Testing Treatment outcome United States United States National Institutes of Health Viral Viral Drug Resistance Virus acceptability and feasibility antiretroviral therapy billing data care outcomes cultural competence disparity reduction dynamic system effective intervention ethnic minority population health disparity health literacy improved individual patient innovation medical specialties medically underserved mortality patient oriented prevent programs provider factors psychosocial racial and ethnic racial and ethnic disparities racial minority resistant strain retention rate skills social determinants socioeconomic disadvantage therapy adherence therapy development transmission process treatment disparity

项目摘要

PROJECT SUMMARY Achieving high rates of retention in human immunodeficiency (HIV) care and viral suppression through antiretroviral therapy not only reduces mortality, but also is a means to reduce the incidence of HIV in affected communities because viral suppression greatly decreases communicability and prevents the transmission of resistant strains of the virus. Retention in care and viral suppression have been particularly challenging for minority populations leading to racial and ethnic disparities in HIV outcomes, including survival. Among people living with HIV infection in 2013, the percentage that was virally suppressed was only 51.5% among African Americans, 58.2% among Latinos, and 65.0% among whites. Our central hypothesis is that provider patient- centered care (PCC) factors interacting with dynamic patient psychosocial factors as well as neighborhood social determinants and medical case management site factors are influencing retention in care and viral suppression and thus contributing to health disparities. The objective of this application is to identify provider PCC factors that are moderating the effect of changes in individual characteristics on retention in care and viral suppression while considering neighborhood social determinants and medical case management site factors and to predict to what extent changes in PCC factors could improve HIV care retention and viral suppression and thus reduce health disparities. We will accomplish these objectives with a cohort study of people enrolled in the Miami-Dade County Ryan White Program 2019–2021. The Ryan White Program serves 52% of people living with HIV in the United States, in particular the medically underserved. To test our central hypothesis and achieve the objectives of this application, we propose the following four specific aims: 1) Using causal Bayesian networks, assess the moderating role of HIV provider PCC factors on the association between patient-level characteristics and retention in HIV care, viral suppression, and related health disparities cross- sectionally while accounting for neighborhood-level and medical case management site factors; 2) By means of dynamic causal Bayesian networks, assess the moderating role of HIV provider PCC factors on the association between longitudinal changes in patient-level characteristics and changes in retention in HIV care, viral suppression, and related health disparities; 3) Using dynamic causal Bayesian networks, estimate the magnitude of the expected improvement in retention in HIV care, viral suppression, and related health disparities, produced by changing provider PCC factors; and 4) Identify feasibility and acceptability issues related to potential interventions to address the most influential health disparities factors identified in aims 1–3 using expert interviews and focus group discussions with RWP providers, administrators, and patients. This research thus supports one of the Trans-NIH Plan for HIV-Related Research “cross-cutting” priorities to reduce disparities in treatment outcomes.

项目摘要通过抗逆转录病毒疗法不仅降低了死亡率，而且是减少受影响的HIV事件的一种手段社区是因为病毒抑制大大降低了沟通，并阻止了病毒的抗性菌株。保留护理和病毒抑制作用特别具有挑战性少数群体导致艾滋病毒结局的种族和种族差异，包括生存。中间 2013年患有艾滋病毒感染的艾滋病毒感染，实际上被抑制的百分比仅为51.5％美国人在拉丁美洲人中为58.2％，白人中有65.0％。我们的中心假设是提供者患者 - 中心护理（PCC）因素与动态患者的心理社会因素以及邻里相互作用社会决定者和医疗案例管理站点因素正在影响保留护理和病毒抑制，从而导致健康差异。该应用程序的目的是确定提供商 PCC因素正在调节个体特征变化对保留和病毒的保留率的影响在考虑邻里社会决定者和医疗案例管理站点因素的同时进行镇压并预测PCC因素的变化在多大程度上可以改善HIV护理保留和病毒抑制从而减少健康差异。我们将通过对入学人群进行研究来实现这些目标在2019 - 2021年迈阿密戴德县瑞安·怀特计划中。 Ryan White计划为52％的人提供服务在美国患艾滋病毒，尤其是在医学上服务不足的人。测试我们的中心假设和实现此应用程序的目标，我们提出以下四个特定目的：1）使用休闲贝叶斯网络，评估艾滋病毒提供商PCC因素在关联之间的调节作用患者水平的特征和艾滋病毒护理，病毒抑制和相关健康差异的保留率交叉分区考虑社区级别和医疗案例管理现场因素； 2）通过动态因果贝叶斯网络，评估HIV提供商PCC因素在患者级特征的纵向变化与艾滋病毒护理保留率变化之间的关联，病毒抑制和相关的健康差异； 3）使用动态因果贝叶斯网络，估计艾滋病毒护理，病毒抑制和相关健康的预期保留率的预期改善的幅度分布，由更改提供商PCC因素产生； 4）确定可行性和可接受性问题与潜在的干预措施有关，以解决目标1-3中确定的最具影响力的健康差异因素使用专家访谈和焦点小组讨论与RWP提供者，管理员和患者进行讨论。这因此，研究支持与HIV相关研究的Trans-NIH计划之一，以减少治疗结果的差异。