Epidemiology of Clinical Retention Among HIV-Infected Persons in North America

北美 HIV 感染者临床保留的流行病学

• 批准号: 8540794
• 负责人: Peter F Rebeiro
• 金额: $ 4.22万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8540794
• 关键词: AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Advocate; Aftercare; American; Appointment; Benchmarking; CD4 Lymphocyte Count; Calendar; Canada; Caring; Characteristics; Clinic; Clinical; Code; Collaborations; Data; Data Sources; Detection; Disease Outcome; Disease Progression; Effectiveness; Geographic Factor; HIV; HIV-1; Health; Health Policy; Heterogeneity; Immune; Incidence; Individual; Institute of Medicine (U.S.); Intervention; Laboratories; Letters; Life; Measures; Methods; Minority; Modeling; Monitor; North America; Outcome; Patient Appointment; Patients; Pattern; Patterns of Care; Persons; Policy Maker; Population; Public Health; Recommendation; Recording of previous events; Research; Research Design; Resources; Risk; Scanning; Site; Substance abuse problem; Telephone; Testing; Text; Time; Treatment outcome; United States; Viral Load result; base; clinical care; clinical epidemiology; cohort; federal policy; improved; injection drug use; interest; longitudinal analysis; male; multilevel analysis; novel strategies; public health relevance; statistics; transmission process; trend

DESCRIPTION (provided by applicant): Retention in clinical HIV care has been widely recognized as a key component in improving HIV disease outcomes in individuals and decreasing HIV transmission in populations. Measures of retention in clinical care have varied depending on the available data and the population under study, and various demographic, clinical, and environmental characteristics have been observed influencing patterns of care over time. Recently, the National HIV/AIDS Strategy (NHAS) for the United States advocated improvement in clinical retention rates and the Institute of Medicine outlined measures for assessing both the NHAS and benchmarks in the Affordable Care Act. This research therefore seeks to quantify clinical, sociodemographic, and geographic patterns and correlates of retention in care among HIV-infected persons in the United States (US) and Canada, with a particular focus on individuals with a history of injection drug use (IDU). The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) provides a rich data source that has been endorsed by the Institute of Medicine as an important resource capable of monitoring patterns of care among persons living with HIV/AIDS in the United States and assessing progress in the NHAS. Aim 1 will quantify the concordance of laboratory measures (used as surrogates for direct measures of clinical encounters) with actual clinical encounters between 2000 and 2010. Because laboratory measures are widely used as indicators of access to clinical care, this analysis will be of significant importance and has not been previously addressed. Aim 2 will identify the effectiveness of applied interventions to improve clinical retention among HIV-infected individuals in clinical care in North America over the first decade of the 2000s. Aim 3 will identify factors associated with suboptimal retention in care, between 2000 and 2010: demographic and clinical characteristics after adjusting for time-varying confounding by immune status and substance abuse using causal inference modeling, and geographic characteristics using spatial statistics. Secondary analyses will be performed in each aim to assess the patterns and correlates of care specific to HIV-infected individuals with a history of injection drug use, noted in the NHAS and elsewhere as a population of particular interest in addressing HIV treatment and outcome disparities and effectively implementing novel strategies for reducing HIV transmission.

描述(由申请人提供)：临床艾滋病毒护理的保留已被广泛认为是改善个人艾滋病毒疾病结局和减少艾滋病毒在人群中传播的关键组成部分。临床护理保留的衡量标准因可用数据和研究人群而异，并观察到随着时间的推移，不同的人口统计、临床和环境特征影响护理模式。最近，美国国家艾滋病毒/艾滋病战略(NHAS)倡导提高临床保留率，医学研究所概述了评估NHAS和《平价医疗法案》中的基准的措施。因此，这项研究试图量化美国和加拿大艾滋病毒感染者的临床、社会人口学和地理模式以及保留护理的相关性，特别关注有注射吸毒史的个人。北美艾滋病群体研究和设计合作(NA-ACCORD)提供了丰富的数据来源，该数据来源已得到医学研究所的认可，是能够监测美国艾滋病毒/艾滋病患者的护理模式和评估NHAS进展情况的重要资源。目标1将量化2000年至2010年间实验室测量(用作临床接触直接测量的替代物)与实际临床接触的一致性。由于实验室措施被广泛用作获得临床护理的指标，这一分析将具有重要意义，以前从未涉及过。 目标2将确定应用干预措施的有效性，以改善21世纪头十年北美临床护理中艾滋病毒感染者的临床保留情况。 目标3将确定与2000至2010年间护理保留率不佳有关的因素：使用因果推断模型对免疫状况和药物滥用的时变混淆进行调整后的人口统计和临床特征，以及使用空间统计的地理特征。 将对每个目标进行二次分析，以评估对有注射吸毒史的艾滋病毒感染者的具体护理模式和相互关系，在国家卫生行动计划和其他地方指出，这是一个在解决艾滋病毒治疗和结果差异以及有效实施减少艾滋病毒传播的新战略方面特别感兴趣的人群。