Adherence to HIV Care: Advancing the Science

描述（由申请人提供）：在从事临床护理的hiv感染者中，错过门诊预约是很常见的。错过预约除了对个别病人的健康造成负面影响外，还对艾滋病毒的传播产生重要影响，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依从性的研究明显不足。该提案的目标是深入了解服务不足人群中艾滋病毒预约依从性的障碍，了解错过预约对临床结果的影响，并开发一种临床工具来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，将告知基于理论的干预措施，以改善艾滋病毒预约依从性，以及一个可持续的研究计划的基础，致力于研究艾滋病毒卫生服务的利用和坚持护理。研究计划由统一的概念模型驱动，与明确的测量仪器相联系，以及详细的分析计划。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洲裔美国患者坚持艾滋病毒门诊预约的障碍和促进因素；具体目标2：推导并内部验证一种新颖的，即时护理预测规则，以识别门诊HIV门诊预约不遵守和高风险的患者；具体目标3：评估不遵守HIV门诊预约和重要临床结果之间的潜在剂量-反应关系。具体目标1将通过定性方法来完成，特别是名义群体技术。第二个和第三个具体目标将通过DAB 1917 HIV/AIDS诊所的前瞻性队列研究来实现。这项研究将通过利用优秀的指导和研究环境，扩展首席研究员过去的培训和研究，使他能够获得以患者为导向的艾滋病毒研究的新技能，使他成为一名改善艾滋病毒感染者健康的独立研究者。

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.