Optimizing Rapid and Full Engagement in Care for Persons with Newly Diagnosed HIV

描述（由申请人提供）：疾病控制和预防中心现在建议在所有医疗机构进行常规（非针对性）HIV检测，包括医院急诊科（ED）和紧急护理诊所（UCC）。从急诊护理环境中诊断出的艾滋病毒是治疗和预防工作的一个关键目标人群，特别是因为医疗艾滋病毒检测举措往往服务于城市弱势群体，这些群体因未能参与护理而面临更大的风险。然而，在美国，估计有30-50%的新艾滋病毒诊断在6个月内未能进入护理。关于如何迅速和充分地使最近诊断的艾滋病毒患者参与护理的研究很少。此外，很少有人知道通过常规（非靶向）测试诊断如何影响护理最初几个月的保留。 该提案的目标是了解快速和全面参与艾滋病毒护理的决定因素，并制定促进艾滋病毒护理的战略，这项研究以一个概念-理论模型为指导，该模型为衡量工具和结构化研究计划提供信息。对于在旧金山弗朗西斯科总医院艾德/UCC通过常规（非靶向）检测确诊为艾滋病毒感染者并在SFGH艾滋病毒诊所建立护理的患者，具体目标是：1）确定快速全面参与护理的障碍和促进因素; 2）确定快速全面参与艾滋病毒护理的预测因素; 3）制定干预措施，促进快速全面参与艾滋病毒护理。具体目标1将通过定性方法实现。具体目标2将通过社会人口统计学、行为和临床变量的基线评估以及使用电子病历跟踪预约和临床结局来实现。具体目标3将通过分析目标1和2的数据、相关领域的文献综述和利益相关者的投入来实现。 通过有针对性的课程作业和辅导培训计划，候选人将发展定性调查、基于群体的流行病学方法、行为理论和干预开发方面的技能，以实现这些具体目标，并为成为一名致力于缩小艾滋病毒病例识别和护理启动之间的差距的独立调查员奠定基础。 公共卫生相关性：在美国，艾滋病毒筛查已扩展到急诊室和紧急护理诊所等急性医疗环境，无论就诊原因如何，都为患者提供检测。关于新诊断的艾滋病毒患者如何在急性医疗环境中建立门诊艾滋病毒护理知之甚少。这项研究将有助于确定快速和全面参与艾滋病毒护理的关键因素，并制定干预措施来支持这一进程。

DESCRIPTION (provided by applicant): The Centers for Disease Control and Prevention now recommends routine (non-targeted) HIV testing in all health care settings, including hospital emergency departments (EDs) and urgent care clinics (UCCs). HIV diagnoses from acute care settings represent a key target population for treatment and prevention efforts, especially since medical HIV testing initiatives often serve vulnerable urban groups who have been shown to be at increased risk for failing to engage in care. However, an estimated 30-50% of new HIV diagnoses in the U.S. fail to enter care within 6 months. Few studies exist on how to rapidly and fully engage recently diagnosed HIV patients in care. Moreover, little is known about how being diagnosed via routine (non-targeted) testing impacts retention in the first months of care. The goals of this proposal are to generate knowledge about the determinants of rapid and full engagement in HIV care and develop strategies to promote it. This research is guided by a conceptual- theoretical model that informs measurement instruments and a structured research plan. For patients diagnosed with HIV via routine (non-targeted) testing in the San Francisco General Hospital ED/UCC and who establish care in the SFGH HIV clinic, specific aims are to: 1) Identify barriers to and facilitators of rapid full engagement in care; 2) Determine predictors of rapid full engagement in HIV care; 3) Develop an intervention to promote rapid full engagement in HIV care. Specific Aim 1 will be accomplished via qualitative methods. Specific Aim 2 will be accomplished through baseline assessment of socio-demographic, behavioral, and clinical variables and use of the electronic medical record to track appointment and clinical outcomes. Specific Aim 3 will be accomplished through analysis of data from Aims 1 & 2, a literature review of related fields, and stakeholder input. Through a focused program of coursework and mentored training, the candidate will develop the skills in qualitative inquiry, cohort-based epidemiologic approaches, behavioral theory and intervention development to execute these specific aims and lay the foundation to become an independent investigator dedicated to closing the gap between HIV case identification and care initiation. PUBLIC HEALTH RELEVANCE: HIV screening in the U.S. has expanded to acute medical settings, such as emergency departments and urgent care clinics, where patients are offered testing regardless of the reason for the visit. Little is known about how patients newly diagnosed with HIV in acute medical settings establish outpatient HIV care. This research will help identify key factors in rapid and full engagement in HIV care and develop an intervention to support this process.