Attitudes and Beliefs and the Steps of HIV Care

描述（由申请人提供）：高效抗逆转录病毒疗法（HAART）显着提高艾滋病毒患者的生存率。高效抗逆转录病毒疗法在常规护理中的有效性取决于患者能否成功遵循艾滋病毒护理的某些关键步骤，包括1）获得门诊护理，2）利用护理和治疗服务，3）坚持护理。然而，即使在HAART时代，约40%的艾滋病毒感染者在诊断后6个月内没有进入护理，坚持治疗仍然是各级的挑战。迄今为止的研究还无法通过艾滋病毒护理的整个步骤跟踪患者。因此，我们不清楚为什么病人对护理的参与如此之差，或者不充分遵循艾滋病毒护理步骤的临床和社会后果。这个应用程序是创新的，预备服务研究。研究艾滋病毒护理步骤需要三个基本要素：患者和医疗保健系统相互作用的有效模型，测量关键结构的有效工具，以及分析这些极其复杂数据的方法。我们将在一项前瞻性观察性队列研究的背景下实现这些要素，该研究在HIV诊断时招募患者，每3个月随访一次，持续18个月。我们将实现三个目标：1）评估对艾滋病毒疾病和护理的态度和信念随着时间的推移的关系，并将这些态度和信念与成功遵循艾滋病毒护理步骤联系起来。2)这是一个简单的视觉模拟量表，用于评估在常规护理中新开始HAART的患者对HAART的依从性。3)测试潜在增长曲线分析的鲁棒性，以模拟态度和信念随时间的变化，以及非递归因果建模与纵向数据分析技术，以评估艾滋病毒护理模型的每个组成部分对健康结果的影响。这些研究将使我们能够确定改善结果的可修改因素，并将艾滋病毒护理步骤作为目标，其中应重点采取干预措施，以最大限度地发挥影响。

DESCRIPTION (provided by applicant): Highly active antiretroviral therapy (HAART) dramatically improves the survival of patients with HIV. The effectiveness of HAART in routine care is determined by the success with which patients are able to follow certain crucial Steps of HIV Care, which includes 1) access outpatient care, 2) utilize care and treatment services, and 3) adhere to care. Yet even in the HAART era, about 40% of persons with HIV do not enter care within 6 months after diagnosis, and adherence remains a challenge at all levels. Studies to date have not been able to follow patients through the entire Steps of HIV Care. As a result, we do not have a clear understanding of why patients so poorly engage in care, or the clinical and societal consequences of inadequately following the Steps of HIV Care. This application is for innovative, preparatory services research. Three essential elements are needed to study the Steps of HIV Care: a validated model for the interaction of patient and health care system, validated instruments to measure key constructs, and a methodology to analyze these extremely complex data. We will achieve these elements in the context of a prospective observational cohort study of patients enrolled at the time of HIV diagnosis, followed every 3 months for 18 months. We will accomplish 3 aims: 1) Assess the relation of attitudes and beliefs about HIV disease and care over time and relate those attitudes and beliefs with success in following the Steps of HIV Care. 2) Validate a simple visual analogue scale-based instrument for assessing adherence to HAART in patients newly starting HAART in routine care. 3) Test the robustness of latent growth curve analysis for modeling changes in attitudes and beliefs overtime, and non-recursive causal modeling with longitudinal data analysis techniques for assessing the impact of each component of the Steps of HIV Care model on health outcomes. These studies will allow us to identify modifiable factors for improving outcomes, and target the Step of HIV Care where interventions should be focused to maximize impact.