Adherence to HIV Care: Advancing the Science

描述（由申请人提供）：错过门诊预约在从事临床护理的艾滋病毒感染患者中很常见。除了对个别病人的负面健康后果外，错过预约对艾滋病毒的传播有重要影响，包括耐药病毒的传播，这是一个严重的公共卫生问题。对艾滋病毒门诊预约的遵守情况显然研究不足。该提案的目标是提供有关在服务不足的人群中坚持艾滋病毒预约的障碍的见解，以产生有关错过预约对临床结果的影响的知识，并开发一种临床工具，以识别未来错过就诊的高风险患者。总的来说，这项研究将提供一个框架，为基于理论的干预提供信息，以提高艾滋病毒预约依从性，并为致力于研究艾滋病毒卫生服务利用和依从性的可持续研究计划奠定基础。研究计划由一个统一的概念模型驱动，与明确的测量工具和详细的分析计划相联系。该提案的具体目标是：具体目标1：确定缺乏私人医疗保险的非裔美国人患者门诊HIV诊所预约依从性的障碍和促进因素;具体目标2：推导并内部验证一种新的床旁预测规则，以识别门诊HIV诊所预约不依从性的高风险患者;具体目标3：评估不遵守门诊HIV预约与重要临床结局之间的潜在剂量-反应关系。具体目标1将通过定性方法，特别是名义群体技术来实现。第二和第三个具体目标将通过在DAB 1917 HIV/AIDS诊所进行的前瞻性队列研究来实现。这项研究将扩大主要研究者过去的培训和研究，利用优秀的指导和研究环境，使他能够获得以患者为导向的艾滋病毒研究的新技能，使他成为一名独立的研究者，改善艾滋病毒感染者的健康。 非正式声明：在艾滋病毒感染者中，错过诊所就诊是常见的，可能会导致艾滋病毒传播给他人。这项研究旨在更好地了解艾滋病毒患者错过诊所就诊的原因。

DESCRIPTION (provided by applicant): Missed outpatient clinic appointments are common among HIV-infected patients engaged in clinical care. Compounding the negative health consequences for individual patients, missed appointments have important implications for HIV transmission, including spread of resistant virus, a serious public health consideration. Adherence to outpatient HIV clinic appointments has been notably understudied. The goals of this proposal are to provide insight on barriers to HIV appointment adherence in an underserved population, to generate knowledge regarding the impact of missed appointments on clinical outcomes, and to develop a clinical tool to identify patients at high risk for future missed visits. Collectively, this research will provide a framework that will inform a theory-based intervention to improve HIV appointment adherence, as well as a foundation for a sustainable research program dedicated to studying HIV health services utilization and adherence to care. The research plan is driven by a unified conceptual model, linked with explicit measurement instruments, and a detailed analysis plan. The specific aims for this proposal are to: Specific aim 1: Determine barriers and facilitators to outpatient HIV clinic appointment adherence among African American patients lacking private health insurance; Specific aim 2: Derive and internally validate a novel, point-of-care prediction rule to identify patients at high risk for outpatient HIV clinic appointment non- adherence and; Specific aim 3: Evaluate potential dose-response relationships between non-adherence to outpatient HIV clinic appointments and important clinical outcomes. Specific aim 1 will be accomplished through qualitative methods, specifically Nominal Group Technique. The 2nd and 3rd specific aims will be accomplished through a prospective cohort study at the DAB 1917 HIV/AIDS Clinic. This research will expand upon the Principal Investigator's past training and research by taking advantage of an outstanding mentoring and research environment, allowing him to acquire new skills in the conduct of patient-oriented HIV research, so that he will become an independent investigator improving the health of people with HIV. Lay statement: Among persons with HIV, missed clinic visits are common and may contribute to the spread of HIV to others. This research seeks to better understand reasons that HIV patients miss clinic visits.