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：VA是美国最大的艾滋病毒护理单一提供商 在美国，大约有5％的HIV感染者。现代艾滋病毒治疗已经改变 这种致命的感染对可治疗的慢性疾病。为了最大程度地受益于艾滋病毒治疗， 退伍军人必须在艾滋病毒护理中进行连续。他们必须在早期的早期诊断 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中，即定期参加 安排终生的医疗任命。我们已经表明保留不佳 艾滋病毒医疗保健是退伍军人今天死于艾滋病毒/艾滋病的主要原因之一。没有 经过验证的干预措施，以更好地保留艾滋病毒初级保健的人。我们的团队一直在研究 保留艾滋病毒护理超过7年。 目标：目标1：定义沿着艾滋病毒感染的护理退伍军人的连续体 在艾滋病毒护理中保留率最大的挑战；并确定那些退伍军人的位置 在保留率方面的困难最终与VA医疗保健系统接口。目的 2：确定延迟联系与护理和保留在艾滋病毒护理中的预测因素 随着时间的流逝，要确定成功导航的促进者和障碍 艾滋病毒护理的连续性，并确定改善护理连续体导航的方法。 目标3：开发和初步测试一种干预措施，以改善在艾滋病毒护理中的保留率 VA。我们希望可以开发和测试可再现的可行干预措施。 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。我们将分析VA的临床病例登记处HIV（CCR HIV）以完成AIM 1 和目标2的一部分。此数据集是所有艾滋病毒感染的退伍军人的全面注册表 自1989年以来使用VA的人。我们将与此进行回顾性队列研究 国家数据集。我们将使用Michael E.的退伍军人的定性研究方法。 Debakey VA医疗中心和伯明翰VA医疗中心完成其余的 AIM 2和AIM 3。定性工作将在门诊护理中招募退伍军人，其中大多数 将有一些对约会的依从性不佳的事件。我们还将招募患者 患有艾滋病毒感染的住院，其中许多人目前将脱离艾滋病毒初级保健。我们将 直接向退伍军人询问促进者和护理障碍，干预措施的建议以及 有关可能的干预措施的反馈。这些混合方法将导致完整的图片 预测艾滋病毒护理中保留率的因素，以便可以适当针对干预措施。 他们还将对促进者和护理障碍有全面的了解， 以及根据艾滋病毒感染的退伍军人建议解决这些问题的策略 自己。这些数据将合并并呈现给咨询面板，并通过 迭代试点测试过程我们将开发初步干预措施，以提高保留率 HIV初级保健。迭代试点测试过程将再次从 退伍军人如何最大化干预措施。因此，干预措施开发了 工作将在随后的工作中进行全面测试和传播。