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.

项目概要通过以下方式实现人类免疫缺陷 (HIV) 护理和病毒抑制的高保留率抗逆转录病毒治疗不仅可以降低死亡率，而且是减少受影响人群艾滋病毒发病率的一种手段社区，因为病毒抑制大大降低了传染性并阻止了传播病毒的耐药株的保留和病毒抑制对患者来说尤其具有挑战性。少数民族人口导致艾滋病毒结果（包括生存率）方面的种族和民族差异。 2013年非洲艾滋病毒感染者中病毒被抑制的比例仅为51.5% 美国人中，58.2% 为拉丁裔，65.0% 为白人。我们的中心假设是，提供者患者—— 以中心护理（PCC）因素与动态患者心理社会因素以及邻里相互作用社会决定因素和医疗案例管理场所因素正在影响护理和病毒的保留抑制，从而导致健康差异该应用程序的目的是识别提供者。调节个人特征变化对护理保留和病毒影响的 PCC 因素抑制，同时考虑社区社会决定因素和医疗案例管理站点因素并预测 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我们将通过对登记者进行队列研究来实现这些目标。迈阿密戴德县 Ryan White 计划 2019-2021 Ryan White 计划为 52% 的人提供服务。在美国感染艾滋病毒的人，特别是医疗服务不足的人，以检验我们的中心假设和。为了实现此应用程序的目标，我们提出以下四个具体目标：1）使用因果关系贝叶斯网络，评估 HIV 提供者 PCC 因素对两者之间关联的调节作用患者层面的特征以及对艾滋病毒护理、病毒抑制和相关健康差异的坚持 2）采取分段方式，兼顾街道层面和医案管理站点因素；动态因果贝叶斯网络，评估 HIV 提供者 PCC 因素对患者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方面的预期改善程度因供应商 PCC 因素的变化而产生的差异；以及 4) 确定可行性和可接受性问题与解决目标 1-3 中确定的最具影响力的健康差异因素的潜在干预措施相关通过与 RWP 提供者、管理人员和患者进行专家访谈和焦点小组讨论。因此，研究支持跨国家卫生研究院艾滋病毒相关研究计划之一的“跨领域”优先事项，以减少治疗结果的差异。