HIV Care Utilization: A theory-based approach to retention in care

HIV 护理利用：一种基于理论的保留护理方法

• 批准号: 8071942
• 负责人: Laramie Rae Smith
• 金额: $ 3.27万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8071942
• 关键词: Address; Adherence; Area; Attention; Behavior; Behavioral; Caring; Clinic; Clinic Visits; Communities; Development; Enrollment; Evaluation; HIV; HIV Seropositivity; Health; Individual; Intervention; Life; Literature; Maintenance; Measures; Medical; Modeling; Motivation; Outcome; Patients; Population; Process; Public Health; Research; Resistance; Sampling; Services; Testing; Time; Translating; Viral Load result; Work; base; clinical care; cohort; design; effective intervention; improved; indexing; inner city; motivational enhancement therapy; patient oriented; post intervention; psychologic; public health relevance; skills; social; theories; therapy design

DESCRIPTION (provided by applicant): Inconsistent use of HIV medical care has been associated with potentially dire outcomes for both the individual HIV positive patient in care and the surrounding community due to increased burden of individual- and community-level viral load. While there have been recent intense efforts to enroll people living with HIV (PLWH) into care and to re-engage PLWH lost to care, less is known about factors influencing sustained maintenance in HIV-care once initiated or re-initiated, despite this group's particular vulnerability to additional complications (such as resistance due to intermittent adherence) and the window of opportunity for clinic- based intervention that they present. The proposed work aims to address this gap in the literature and unmet service-related needs through the development and evaluation of a theory based model of retention in care and a brief targeted intervention to support retention in care for those tenuously engaged. We adapt the well- established the Information-Motivation-Behavioral Skills (IMB) model to retention in HIV medical for use in two studies. This IMB model is used to identify the core psycho-social processes in terms of the types of information, motivation, and behavior skills needed to sustain regular use of HIV medical care over time by identifying potentially modifiable deficits in these psychological processes that can be used to inform retention- related intervention strategies. In Study 1 we will use a cross-sectional IMB-based measure of retention in care to test the model and identify the critical levels of information, motivation, and behavioral skills related to retention in care within an inner-city clinic sample. Specifically, our first aim is to test an Information- Motivation- Behavioral Skills Model of retention in HIV medical care in an inner-city clinic population. Study 2 will pilot an intensive single-session motivational-interviewing based intervention that uses an IMB- model based screener to identify individual model-based barriers to retention in care to tailor the patient- centered discussion targeting adherence to the next clinic visit specifically for patients who have gapped in HIV care over the last year and a half. This intervention will be evaluated against a time and attention control condition within the same cohort on objective indices of care utilization six months post intervention, as well as on immediate post-intervention changes in information, motivation, and behavioral skills. Thus, our second aim is to design, implement, and evaluate a proof-of-concept clinic-based intervention designed to address core IMB model determinants of retention in care, and promote retention in care in a tenuously engaged inner-city sample. The proposed project will contribute uniquely to this area of inquiry and have practical implications for viable intervention approaches for controlling individual- and community-level viral burden. PUBLIC HEALTH RELEVANCE: The proposed project will test an Information Motivation Behavioral Skill model of retention in HIV medical care and evaluate a brief targeted intervention to promote retention in care via improvements in the core factors identified by this mode, which uniquely contributes to this area of research by providing a comprehensive model of retention that can be easily translated to effective intervention approaches. The pilot of the targeted theory-based intervention has implications for both extending our understanding of effective interventions for retention in care as well as for providing guidance for potential strategies to promote engagement delivered at the point of clinical care. Such efforts to enhance and sustain retention in care are necessary to achieve improved health and significant reductions in viral load critical to individual and public health.

描述（由申请人提供）：由于个体和社区水平的病毒载荷负担增加，对艾滋病毒医疗保健的使用不一致与个人艾滋病毒阳性患者和周围社区的潜在可怕结果有关。尽管最近已经做出了激烈的努力，即让艾滋病毒（PLWH）的人们接受护理并重新接触PLWH，但对一旦发起或重新启动的艾滋病毒保养的持续维持的因素来说，却少知道，尽管该集团的启动或重新启动特别容易发生其他并发症（例如由于间歇性依从性引起的抵抗）和基于临床干预的机会之窗。拟议的工作旨在通过开发和评估基于理论的保留在护理中的保留和简短的有针对性的干预措施来支持保留保留护理方面的文献和评估，以解决文献中的这一差距和未满足的服务相关的需求。我们适应了良好的信息动机行为技能（IMB）模型，以保留在HIV Medical中，以在两项研究中使用。该IMB模型用于根据信息，动机和行为技能的类型来识别核心心理社会过程，以通过在这些心理过程中识别潜在可修改的赤字，以维持艾滋病毒医疗保健所需的定期使用，以使用这些心理学过程告知与保留相关的干预策略。在研究1中，我们将使用基于IMB的基于IMB的保留量测试模型测试模型，并确定与内城市诊所样本中保留的关键信息，动机和行为技能的关键水平。具体而言，我们的第一个目的是测试城市诊所人口中HIV医疗保留的信息动机行为技能模型。研究2将试用基于IMB模型的筛选器的基于IMB模型的筛选器的基于密集的单会动机干预措施，以确定基于单个模型的保留障碍，以量身定制以患者为中心的讨论，针对针对下一次诊所的患者进行专门访问的患者讨论在过去的一年半中，他们陷入了艾滋病毒护理。该干预措施将根据同一队列中的时间和注意力控制条件进行评估，以在干预后六个月以及对信息，动机和行为技能的立即进行干预后的变化。因此，我们的第二个目的是设计，实施和评估旨在解决核心IMB保留率的核心IMB模型决定因素，并在繁重参与的内部城市内部样本中促进保留保留率的基于概念诊所的干预措施。拟议的项目将为这一探究领域提供独特的贡献，并对可行的干预方法具有控制个人和社区级别的病毒负担的实际影响。 公共卫生相关性：拟议的项目将测试信息动机行为技巧在艾滋病毒医疗保健中保留的行为技能模型，并评估短暂的有针对性的干预措施，通过改进该模式确定的核心因素来促进保留保留，这为这一领域唯一贡献了这一领域通过提供一个可以轻松转化为有效干预方法的全面保留模型来进行研究。基于靶向理论的干预措施的试点对我们对保留保留的有效干预措施的理解以及为促进在临床护理时提供的参与度提供指导的指导具有意义。为了改善健康和对个人和公共卫生至关重要的病毒负荷的大幅减少，必须进行加强和维持保留的努力。