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

基本信息

批准号：
7938885
负责人：
Thomas P Giordano
金额：
$ 69.16万
依托单位：
BAYLOR COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
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/7938885
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 Country Data Developed 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

项目摘要

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）：医疗护理保留率低是当今人们死于艾滋病毒/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变为可治疗的慢性疾病。目前还没有经过证实的干预措施可以更好地让人们接受艾滋病毒初级保健。感染艾滋病毒的住院患者面临护理持续不佳的高风险。对于大多数脱离护理的患者来说，单次或双次干预是必不可少的，因为任何可以被招募参加多次干预的患者都可能被招募回初级保健。我们的团队七年多来一直在研究艾滋病毒护理的保留情况。使用信息-动机-行为技能模型作为框架，我们的数据表明，在最近诊断出艾滋病毒感染的患者中，获得艾滋病毒初级保健的机会受到有关护理和治疗可用性的关键信息差距、与不良应对相关的动机有限的影响对医疗保健系统的策略和信任度低，以及行为技能薄弱，反映在坚持艾滋病毒护理方面的自我效能感和社会支持低。这些因素导致人们无法顺利进入医疗保健系统并继续接受艾滋病毒护理。我们开发了一个结构化的、基于理论的患者导师计划。患者导师计划旨在通过增加患者对艾滋病毒和护理系统的了解、提高自我效能和促进积极的自我管理来提高艾滋病毒初级护理的保留率。在托马斯街健康中心的一次性互动中，志愿者患者导师迎接前来诊所就诊的新患者，指导他们完成就诊并为他们提供支持。在我们的初步准实验数据中，在就诊期间有患者导师的患者中有 88% 在接下来的 90 天内完成了医生就诊，而没有导师的患者则为 78% (p<.001) 。在调整基线人口统计和临床特征后，这些影响仍然显着，并持续到摄入后 90-180 天的间隔。我们将在一项为期 5 年的随机对照试验中测试 TSHC 患者导师干预的效果，该试验对本陶布综合医院住院的 434 名社会经济和种族多样化的 HIV 感染患者进行。我们假设，与注意力控制相比，干预措施将有意义地提高出院后艾滋病毒初级保健的保留率。我们的具体目标是： 1) 测试患者导师干预对出院后继续接受艾滋病毒初级保健的效果； 2) 测试患者导师干预对次要结果的有效性，包括卫生服务的使用、与健康相关的生活质量和临床结果； 3) 确定与干预反应相关的中介因素，以及艾滋病毒初级保健中个人和系统的促进因素和障碍。这项研究解决了当今艾滋病毒护理中最重要的挑战之一，即将现代艾滋病毒治疗扩展到所有有需要的人，并且还可能影响艾滋病毒感染者健康方面基于种族的差异。公共卫生相关性：医疗护理保留率低是当今人们死于艾滋病毒/艾滋病的主要原因之一。我们开发了一个结构化的、基于理论的患者导师计划，以提高艾滋病毒初级保健的保留率。我们将在一项为期 5 年的随机对照试验中测试这种患者导师干预的效果，该试验对本陶布综合医院 (Ben Taub General Hospital) 住院的 400 多名社会经济和种族多样化的 HIV 感染患者进行。