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

项目摘要 通过以下措施实现高的艾滋病毒护理和病毒抑制保留率 抗逆转录病毒治疗不仅降低死亡率，而且是降低受影响人群中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播性，并防止传播 抵抗病毒的菌株。保持护理和病毒抑制对于 少数群体的艾滋病毒感染导致艾滋病毒结果的种族和族裔差异，包括生存率。人与人之间 2013年，非洲艾滋病毒感染者中，病毒抑制率仅为51.5%， 美国人中，58.2%是拉丁裔，65.0%是白人。我们的核心假设是提供者- 中心化护理（PCC）因素与动态患者心理社会因素以及邻居相互作用 社会决定因素和医疗病例管理地点因素正在影响护理保留率， 抑制，从而造成健康差距。此应用程序的目的是确定提供商 PCC因素是调节个体特征变化对保持护理和病毒感染的影响。 抑制，同时考虑邻里社会因素和医疗病例管理现场因素 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 从而减少健康差距。我们将通过对入选者进行队列研究来实现这些目标 迈阿密戴德县瑞安白色计划2019-2021。瑞安白色计划为52%的人提供服务 艾滋病毒感染者在美国，特别是医疗服务不足。为了验证我们的核心假设， 为了实现本申请的目的，我们提出了以下四个具体目标：1）使用因果关系 贝叶斯网络，评估艾滋病毒提供者PCC因素对之间关联的调节作用 患者水平的特征和艾滋病毒护理的保留，病毒抑制和相关的健康差异， 分区，同时考虑社区水平和医疗病例管理现场因素; 2）通过手段 动态因果贝叶斯网络，评估艾滋病毒提供者PCC因素对艾滋病毒感染的调节作用。 患者水平特征的纵向变化与艾滋病毒护理保留率的变化之间的关联， 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 在艾滋病毒护理、病毒抑制和相关健康方面预期改善的幅度 差异，由不断变化的供应商PCC因素产生;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距因素的潜在干预措施有关 使用专家访谈和与RWP提供者、管理者和患者的焦点小组讨论。这 因此，研究支持跨NIH计划的艾滋病毒相关研究“交叉”优先事项之一，以减少 治疗结果的差异。

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.