Understanding antiretroviral adherence changes from the community to the nursing home

项目摘要 艾滋病毒感染者的养老院（NH）居民的抗逆转录病毒治疗（ART）依从性低于最佳水平; 文献显示，21%的HIV感染者没有从他们的NH接受ART，这与87.5%的依从性形成对比。 社区老年艾滋病毒感染者中。ART维持病毒抑制，防止恶化 慢性病和早期死亡，停止抗逆转录病毒疗法很少表示。因此，最佳ART依从性 在NH设置中，只有通过了解索赔中记录的促进者和障碍才能实现 and perceived感知by older老people with HIV艾滋病毒.这项混合方法研究将评估ART治疗期间的依从性。 社区到长期停留-NH-过渡期的三个目标：目标1将确定人的水平，和NH-水平， 与社会经济多样化的医疗保险和医疗补助特殊人群中ART依从性变化相关的因素 需求计划（SNP）。目标2将评估长期居住在NH的艾滋病毒感染者的看法和经验 通过定性访谈和目标3将检查与ART相关的一致和不一致因素 通过三角测量遵守目标1和2。定量分析将使用两个数据库：1）医疗保险5% 增强样本; 2）来自纽约市医疗补助HIV SNP的声明。Logistic和线性回归 使用广义估计方程，将检查ART依从性从6个月前到 获得NH长期居留身份（连续入组1年）后的前3个月。随后，委员会注意到， 定性访谈将侧重于50岁以上艾滋病毒感染者的观点和经验， 关于促进者和ART坚持的障碍，而他们是一个长期居住的NH居民。招募 通过两个组织，访谈将是半结构化的，并使用NVivo软件进行分析， 通过扎根理论分析建立归纳和演绎理论，直到主题饱和。 使用协调和初始化技术的三角测量将解决定量和 定性结果。结果将提供细微差别以外的行政索赔数据，包括社会 决定因素和生命历程经验（例如，住房不稳定）。这项工作将扩大梅博士的技能， 包括Medicaid SNP数据、定性和混合方法研究。她将得到四位共同导师的支持 在老年医学，二手数据和定性和混合方法的研究，以及卫生政策， 除了通过东北大学和相关资源的正式培训。这种职业发展 获奖将完成梅博士的技能，努力研究，以达到人口，从而帮助建立她作为 她是艾滋病和老龄化领域的独立研究者和领导者。它也将是未来R 01研究的基础， 分析卫生保健利用和健康结果与艺术坚持在NH。

Project Summary Antiretroviral therapy (ART) adherence among nursing home (NH) residents with HIV is less than optimal; in the literature 21% of people with HIV had no ART from their NH, which is in contrast to the 87.5% adherence among community dwelling older people with HIV. ART maintains viral suppression, prevents worsening of chronic conditions and early mortality, and stopping ART is rarely indicated. Therefore optimal ART adherence in the NH setting can only be achieved by understanding facilitators and barriers both documented in claims and perceived by older people with HIV. This mixed methods study will assess ART adherence during the community-to-long-stay-NH-transition period in three aims: Aim 1 will identify person-level, and NH-level, factors associated with changes in ART adherence in socioeconomically diverse Medicare and Medicaid special needs plan (SNP) claims. Aim 2 will assess perceptions and experiences of long-stay NH residents with HIV through qualitative interviews and Aim 3 will examine concordant and discordant factors associated with ART adherence by triangulation of Aims 1 and 2. Quantitative analyses will use two databases 1) Medicare 5% enhanced sample; 2) claims from a New York City-based Medicaid HIV SNP. Logistic and linear regression with generalized estimating equations will examine the change in ART adherence from the 6 months prior, to the first three months after achieving NH long-stay status (1-year continuous enrollment). Subsequently, qualitative interviews will focus on perspectives and experiences of people living with HIV aged 50+ with regard to facilitators and barriers to ART adherence while they were a long-stay NH residents. Recruited through two organizations, interviews will be semi-structured and analyzed with NVivo software using inductive and deductive theory building through grounded theory analysis and until thematic saturation is met. Triangulation using reconciliation and initiation techniques will address discordance between quantitative and qualitative findings. The results will provide nuance beyond administrative claims data by including social determinants and life course experiences (e.g., housing instability). This work will expand Dr Mui’s skills to include Medicaid SNP data, qualitative and mixed-methods research. She will be supported by four co-mentors with expertise in geriatrics, secondary data and qualitative and mixed-methods research, and health policy, in addition to formal training through Northeastern University and related resources. This career development award will complete Dr. Mui’s skills for researching hard to reach populations thereby helping establish her as an independent researcher and leader in HIV and aging. It will also be foundational to future R01 research to analyze healthcare utilization and health outcomes associated with ART adherence in the NH.