Maximizing respect and improving outcomes in HIV and substance abuse (MaRIPOHSA)

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DESCRIPTION (provided by applicant): Despite a well-established evidence base that respectful patient-provider relationships are critically important to patient outcomes, there are wide gaps in our current understanding of patient-clinician communication in the treatment of HIV/AIDS and drug abuse. A recent systematic review finds that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care. The significant problem to be addressed over the 5-year award period is that healthcare professionals do not always communicate effectively and build therapeutic alliance with patients, especially those with HIV/AIDS and drug abuse, which can lead to patients' experiences of disrespect and undermine recovery, adherence to therapy, retention in care, and health outcomes. The long term goal of this research is to improve the quality of HIV care through the development and dissemination of effective interventions to improve respect and patient- provider communication quality. In order to do so, we must develop explicit, practical recommendations and training interventions for clinicians. To take the next step toward meeting this critical need, the overall objective of this application is to establish an innovative audio specimen repository that can be used to distinguish prospectively which patient and provider communication behaviors are important to patient outcomes in those with current or a past history of substance use. Our specific aims are (1) to establish and maintain an innovative specimen repository of audio recorded routine encounters between primary HIV providers and patients as part of an existing cohort study in which patient outcomes are continually assessed, and (2) to apply existing communication coding schemes to a subset of these audio recorded encounters to understand how respect is manifested (or not) through communication with patients in routine encounters and, using a case-control design, to assess the association of particular communication behaviors with patient outcomes such as enrollment and retention in substance use treatment, adherence to ARV therapy, and retention in HIV care. By exploring the complexity of respect and communication in the treatment of substance use and HIV/AIDS with an innovative audio specimen bank embedded in a well-established cohort study, we will have a resource within which this and future case-control studies can utilize rapidly developing communication analysis techniques to identify areas where communication should be improved, evaluate mechanisms by which communication impacts patient outcomes, and perhaps most importantly will develop strategies for clinicians to enhance respect and improve communication among HIV-infected patients with drug abuse.