Developing an Intervention to Retain HIV-infected Veterans in HIV Care

制定干预措施，让感染艾滋病毒的退伍军人继续接受艾滋病毒护理

• 批准号: 8182121
• 负责人: Thomas P Giordano
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8182121
• 关键词: AIDS/HIV problem; Accident and Emergency department; Adherence; Affect; African American; Ambulatory Care; Appointment; CCR; Caring; Chronic; Chronic Disease; Clinical; Cohort Studies; Continuity of Patient Care; Data; Data Set; Databases; Developed Countries; Diagnosis; Disease; Ethnic Origin; Feedback; Goals; Grant; HIV; HIV Infections; Health; Healthcare; Healthcare Systems; Hepatitis C; Highly Active Antiretroviral Therapy; Hospitalization; Immunology; Infection; Inpatients; Intervention; Laboratories; Lead; Life; Link; Medical; Medical center; Mental disorders; Methods; Military Personnel; Minority Groups; Outcome; Outpatients; Patients; Pattern; Persons; Pharmacy facility; Population; Predictive Factor; Primary Health Care; Process; Provider; Qualitative Methods; Qualitative Research; Race; Randomized Controlled Trials; Recruitment Activity; Registries; Research; Research Methodology; Rest; Risk; Schedule; Science; Solid; Staging; Suggestion; Testing; Time; United States; Veterans; Work; base; design; experience; improved; medical appointment; meetings; mortality; racial and ethnic disparities; tool

Background: The VA is the largest single provider of HIV care in the United States, caring for about 5% of all HIV-infected persons in care in the US. Modern HIV treatment has transformed this deadly infection into a treatable chronic condition. To maximally benefit from HIV treatment, Veterans must navigate a continuum of HIV care. They must be diagnosed at an early stage of disease, access or link to HIV medical care, and be retained in HIV care, i.e., attend regularly scheduled medical appointments for the rest of their lives. We have shown that poor retention in HIV medical care is one of the primary reasons Veterans die of HIV/AIDS today. There are no proven interventions to better retain people in HIV primary care. Our team has been researching retention in HIV care for over 7 years. Objectives: Aim 1: To define where along the continuum of care Veterans with HIV infection experience the most challenges with retention in HIV care; and to identify where those Veterans having difficulty with retention in care eventually interface with the VA healthcare system. Aim 2: To identify the predictors of delayed linkage to care and poor retention in HIV care at care entry and over time, to identify the facilitators and barriers to successfully navigating the continuum of HIV care, and to identify methods to improve navigation of the continuum of care. Aim 3: To develop and preliminarily test an intervention to improve retention in HIV care in the VA. We expect that a reproducible, feasible intervention can be developed and tested. Methods: To accomplish these aims, we will conduct a variety of studies, both quantitative and qualitative. We will analyze the VA's Clinical Case Registry HIV (CCR HIV) to complete Aim 1 and part of Aim 2. This dataset is a comprehensive registry of all Veterans with HIV infection who have used the VA since 1989. We will conduct retrospective cohort studies with this national dataset. We will use qualitative research methods of Veterans from the Michael E. DeBakey VA Medical Center and the Birmingham VA Medical Center to complete the remainder of Aim 2 and Aim 3. The qualitative work will recruit Veterans in outpatient care, most of whom will have had some episode of poor adherence to appointments. We will also recruit patients hospitalized with HIV infection, many of whom will be presently out of HIV primary care. We will ask the Veterans directly for facilitators and barriers to care, suggestions for interventions, and feedback on possible interventions. These mixed methods will result in a complete picture of the factors predictive of retention in HIV care so that interventions can be appropriately targeted. They will also result in a comprehensive understanding of the facilitators and barriers to care, and the strategies to remedy these problems as recommended by HIV-infected Veterans themselves. These data will be coalesced and presented to an Advisory Panel, and through an iterative pilot testing process we will develop a preliminary intervention to improve retention in HIV primary care. The iterative pilot testing process will again solicit direct feedback from Veterans on how to maximize the intervention. The intervention developed as a result of this work will be fully tested and disseminated in subsequent work.

背景：退伍军人事务部是美国最大的艾滋病毒护理单一提供者，为 在美国所有接受治疗的艾滋病毒感染者中，约有5%。现代艾滋病毒治疗已经改变了 这种致命的感染变成了一种可以治愈的慢性疾病。为了最大限度地从艾滋病毒治疗中受益， 退伍军人必须在艾滋病毒护理的连续过程中导航。它们必须在早期阶段得到诊断 疾病，获得或链接到艾滋病毒医疗护理，并保留在艾滋病毒护理中，即定期参加 在他们的余生中安排好医疗预约。我们已经证明，在 艾滋病毒医疗是当今退伍军人死于艾滋病毒/艾滋病的主要原因之一。没有 经过验证的干预措施，以更好地将人留在艾滋病毒初级护理中。我们的团队一直在研究 在艾滋病护理中保留7年以上。 目标：目标1：确定感染艾滋病毒的退伍军人的连续护理 体验留住艾滋病毒护理方面的最大挑战；并确定这些退伍军人 在护理方面有困难的人最终会与退伍军人管理局的医疗保健系统对接。目标 2：确定与护理延迟联系和护理中艾滋病毒留存不佳的预测因素 进入并随着时间的推移，确定成功导航的促进者和障碍 艾滋病毒护理的连续性，并找出改进护理连续性导航的方法。 目标3：开发并初步测试一种干预措施，以提高艾滋病患者在护理中的保留率 弗吉尼亚州我们期望能够开发和测试一种可重复性的、可行的干预措施。 方法：为了实现这些目标，我们将进行各种研究，包括定量和 定性的。我们将分析退伍军人管理局的临床病例登记艾滋病毒(CCR HIV)，以完成目标1 和AIM 2的一部分。这个数据集是所有感染艾滋病毒的退伍军人的全面登记 从1989年起就开始使用退伍军人管理局。我们将对此进行回溯性队列研究 国家数据集。我们将使用来自迈克尔·E·李的退伍军人的定性研究方法。 DeBakey VA医疗中心和伯明翰VA医疗中心完成剩余部分 定性工作将招募门诊的退伍军人，他们中的大多数人 将会有一些不遵守约定的插曲。我们还将招募患者 因感染艾滋病毒而住院，其中许多人目前将脱离艾滋病毒初级保健。我们会 直接向退伍军人寻求促进者和护理障碍，建议进行干预，以及 对可能的干预措施的反馈。这些混合的方法将产生一个完整的 预测保留在艾滋病毒护理中的因素，以便干预措施能够适当地有针对性。 它们还将导致对促进者和护理障碍的全面了解， 以及感染艾滋病毒的退伍军人所建议的补救这些问题的策略 他们自己。这些数据将被合并并提交给咨询小组，并通过 迭代试行测试流程我们将制定初步干预措施，以提高在 艾滋病毒初级保健。迭代试行测试过程将再次征求来自 退伍军人如何最大限度地发挥干预作用。干预的结果就是这一点 工作将在随后的工作中得到充分的检验和传播。