HIV Care Utilization: A theory-based approach to retention in care

描述（由申请人提供）：由于个人和社区一级病毒载量的负担增加，不一致地使用艾滋病毒医疗护理与护理中的个体艾滋病毒阳性患者和周围社区的潜在可怕结果相关。虽然最近已作出大量努力，将艾滋病毒感染者（PLWH）纳入护理，并使失去护理的PLWH重新参与，但对一旦开始或重新开始就影响持续维持艾滋病毒护理的因素知之甚少，尽管这一群体特别容易出现其他并发症（如由于间歇性坚持而产生的抵抗力）以及他们所提供的基于诊所的干预的机会之窗。拟议的工作旨在解决文献中的这一差距和未满足的服务相关的需求，通过开发和评估的理论为基础的模型保留在护理和一个简短的有针对性的干预，以支持保留在护理那些勉强从事。我们调整了完善的信息-动机-行为技能（IMB）模型，以保留在艾滋病毒医疗中使用的两项研究。该IMB模型用于识别核心心理社会过程，即随着时间的推移维持定期使用HIV医疗护理所需的信息类型、动机和行为技能，方法是识别这些心理过程中可能可改变的缺陷，这些缺陷可用于告知保留相关干预策略。在研究1中，我们将使用一个横截面的IMB为基础的措施保留在照顾测试模型，并确定关键水平的信息，动机和行为技能相关的保留在一个市中心的诊所样本的照顾。具体来说，我们的第一个目标是测试信息-动机-行为技能模型的保留在艾滋病毒的医疗保健在市中心的诊所人口。研究2将试行一项基于动机访谈的强化单次干预，该干预使用基于IMB模型的筛选器来识别个体基于模型的护理保留障碍，以定制以患者为中心的讨论，目标是针对在过去一年半中在HIV护理中有缺口的患者的下一次门诊访视的依从性。这项干预措施将在同一队列内的时间和注意力控制条件下进行评估，评估干预后6个月的护理利用客观指数，以及干预后信息、动机和行为技能的即时变化。因此，我们的第二个目标是设计，实施和评估一个概念验证的诊所为基础的干预措施，旨在解决核心IMB模型的保留在护理的决定因素，并促进保留在护理在一个脆弱的参与市中心的样本。拟议的项目将对这一领域的调查作出独特的贡献，并对控制个人和社区病毒负担的可行干预方法产生实际影响。 公共卫生相关性：拟议的项目将测试艾滋病毒医疗护理中保留的信息动机行为技能模型，并评估一种简短的有针对性的干预措施，以通过改善这种模式确定的核心因素来促进护理保留，这通过提供一个可以很容易地转化为有效干预方法的全面保留模型，为这一研究领域做出了独特的贡献。试点的有针对性的理论为基础的干预措施的影响，既扩大了我们的理解，有效的干预措施，以保持在护理，以及为潜在的战略，以促进在临床护理点交付的参与提供指导。这种加强和维持护理的努力对于改善健康和大幅减少对个人和公共健康至关重要的病毒载量是必要的。

DESCRIPTION (provided by applicant): Inconsistent use of HIV medical care has been associated with potentially dire outcomes for both the individual HIV positive patient in care and the surrounding community due to increased burden of individual- and community-level viral load. While there have been recent intense efforts to enroll people living with HIV (PLWH) into care and to re-engage PLWH lost to care, less is known about factors influencing sustained maintenance in HIV-care once initiated or re-initiated, despite this group's particular vulnerability to additional complications (such as resistance due to intermittent adherence) and the window of opportunity for clinic- based intervention that they present. The proposed work aims to address this gap in the literature and unmet service-related needs through the development and evaluation of a theory based model of retention in care and a brief targeted intervention to support retention in care for those tenuously engaged. We adapt the well- established the Information-Motivation-Behavioral Skills (IMB) model to retention in HIV medical for use in two studies. This IMB model is used to identify the core psycho-social processes in terms of the types of information, motivation, and behavior skills needed to sustain regular use of HIV medical care over time by identifying potentially modifiable deficits in these psychological processes that can be used to inform retention- related intervention strategies. In Study 1 we will use a cross-sectional IMB-based measure of retention in care to test the model and identify the critical levels of information, motivation, and behavioral skills related to retention in care within an inner-city clinic sample. Specifically, our first aim is to test an Information- Motivation- Behavioral Skills Model of retention in HIV medical care in an inner-city clinic population. Study 2 will pilot an intensive single-session motivational-interviewing based intervention that uses an IMB- model based screener to identify individual model-based barriers to retention in care to tailor the patient- centered discussion targeting adherence to the next clinic visit specifically for patients who have gapped in HIV care over the last year and a half. This intervention will be evaluated against a time and attention control condition within the same cohort on objective indices of care utilization six months post intervention, as well as on immediate post-intervention changes in information, motivation, and behavioral skills. Thus, our second aim is to design, implement, and evaluate a proof-of-concept clinic-based intervention designed to address core IMB model determinants of retention in care, and promote retention in care in a tenuously engaged inner-city sample. The proposed project will contribute uniquely to this area of inquiry and have practical implications for viable intervention approaches for controlling individual- and community-level viral burden. PUBLIC HEALTH RELEVANCE: The proposed project will test an Information Motivation Behavioral Skill model of retention in HIV medical care and evaluate a brief targeted intervention to promote retention in care via improvements in the core factors identified by this mode, which uniquely contributes to this area of research by providing a comprehensive model of retention that can be easily translated to effective intervention approaches. The pilot of the targeted theory-based intervention has implications for both extending our understanding of effective interventions for retention in care as well as for providing guidance for potential strategies to promote engagement delivered at the point of clinical care. Such efforts to enhance and sustain retention in care are necessary to achieve improved health and significant reductions in viral load critical to individual and public health.