Clinic and Population-Based Approaches to Retention in HIV Care

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DESCRIPTION (provided by applicant): This proposal describes a 5-year training and research program that will allow the Principal Investigator to achieve her goal of becoming an independent patient-oriented investigator with expertise in HIV health services, integrating research and public health practice. The proposed program will build on the candidate's prior experience in HIV/STD clinical and epidemiologic research by enhancing her skills in health services research and in the conduct of clinical trials involving behavioral interventions. The training plan will take advantage of an exceptional mentoring team and institutional environment that involves close collaboration between the University of Washington (UW) and the HIV/STD Control Program of Public Health-Seattle & King County (PHSKC). Research Plan - Retention in HIV care is crucial for the successful treatment of HIV infection and the prevention of HIV transmission, but there is no standard definition of retention in HIV care and little research on population-based approaches to monitoring and improving retention in HIV care. The specific aims of this proposal are: Aim 1) To establish a definition of inadequate retention in HIV care that is correlated with health outcomes and to identify factors that predict poor retention in care; Aim 2) To identify healthcare system factors that facilitate retention in HIV care and evaluate the acceptability of potential clinic-based and population-based interventions to improve retention in care; and Aim 3) To develop and conduct a pilot study of an intervention to improve retention in HIV care. We will address Aim 1 with retrospective studies of data from the UW HIV Clinical Information System and the PHSKC surveillance system and with a prospective study of persons with newly diagnosed HIV entering HIV medical care. We will address Aim 2 using qualitative individual interviews with HIV care providers and persons living with HIV/AIDS. We will design an intervention aimed at improving retention in HIV care using the results of the studies from Aims 1 and 2, and we will conduct a pilot study to assess feasibility and acceptability of the intervention (Aim 3). We will then incorporate the results of all of these studies into the design of a future trial to evaluate the effectiveness of the intervention to improve retention in HIV care. This research will lay the groundwork for a larger research program on quality HIV care that will include rigorous evaluation of interventions aimed at improving the delivery of care with consideration for cost-effectiveness. PUBLIC HEALTH RELEVANCE: Ongoing HIV care is necessary for the health of persons living with (HIV/AIDS) and for preventing the transmission of HIV. This project will evaluate measures of retention in HIV care, identify factors that facilitate retention in HIV care, and develop an intervention to increase the retention of patients in HIV care.