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：弗吉尼亚州是美国最大的艾滋病毒护理提供者， 约占美国所有艾滋病毒感染者的5%。现代艾滋病毒治疗已经改变了 将这种致命的感染转化为可治疗的慢性疾病为了最大限度地受益于艾滋病毒治疗， 退伍军人必须接受连续的艾滋病毒护理。他们必须在早期阶段被诊断出来， 疾病，获得或链接到艾滋病毒医疗保健，并保留在艾滋病毒护理，即，经常参加 在他们的余生中安排医疗预约。我们已经证明， 艾滋病毒医疗保健是今天退伍军人死于艾滋病毒/艾滋病的主要原因之一。没有 有效的干预措施，以更好地留住艾滋病毒初级保健的人。我们的团队一直在研究 在艾滋病护理中保持7年以上。 目标：目标1：确定沿着护理退伍军人与艾滋病毒感染的连续性 在保留艾滋病毒护理方面遇到的挑战最多;并确定这些退伍军人 难以保持护理最终与VA医疗保健系统接口。目的 2：确定与护理的联系延迟和护理机构艾滋病毒护理保留率低的预测因素 进入和随着时间的推移，以确定促进者和障碍，以成功地导航 艾滋病毒护理的连续性，并确定方法，以改善导航的连续性护理。 目标3：制定并初步测试一项干预措施，以改善艾滋病毒护理的保留情况， 弗吉尼亚我们希望能够开发和测试一种可重复的、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，包括定量研究和 定性的我们将分析VA的临床病例登记HIV（CCR HIV），以完成目标1 目标2的一部分。该数据集是所有感染艾滋病毒的退伍军人的综合登记册 自1989年以来一直使用VA。我们将进行回顾性队列研究， 国家数据集。我们将使用定性研究方法的退伍军人从迈克尔E。 DeBakey VA医疗中心和伯明翰VA医疗中心完成剩余部分 目标2和目标3。定性工作将招募退伍军人在门诊护理，其中大多数人 会有一些不遵守约定的情况。我们也会招募病人 他们中许多人目前将无法获得艾滋病毒初级保健。我们将 直接向退伍军人询问护理的促进者和障碍，干预建议， 对可能的干预措施的反馈。这些混合的方法将导致一个完整的图片 预测继续接受艾滋病毒护理的因素，以便能够适当地采取有针对性的干预措施。 它们还将导致全面了解护理的促进因素和障碍， 以及艾滋病毒感染退伍军人建议的解决这些问题的策略 自己这些数据将被合并并提交给一个咨询小组，并通过 迭代试点测试过程，我们将制定初步干预措施，以提高保留率 艾滋病初级保健。迭代试点测试过程将再次征求以下方面的直接反馈： 如何最大限度地干预退伍军人。干预措施的发展是由于这一点 这项工作将在以后的工作中得到充分检验和推广。