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Influence of patient-centered HIV care on retention and viral suppression disparities

以患者为中心的艾滋病毒护理对保留和病毒抑制差异的影响

基本信息

批准号：
10058773
负责人：
MARY JO TREPKA
金额：
$ 26.96万
依托单位：
FLORIDA INTERNATIONAL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-01-29 至 2023-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10058773
关键词：
Accounting Address Administrator Adult Affect African American American Attitude Bayesian Network Buffers Caring Case Management Characteristics Client Clinical Clinical assessments Cohort Studies Communication Communities Community Surveys County Data Enrollment Ensure Epidemic Focus Groups Funding HIV HIV Infections Healthcare Systems Housing Human Immunologic Deficiency Syndromes Incidence Individual Influentials Intervention Interview Knowledge Laboratories Latino Medical Minority Groups Neighborhoods Outcome PF4 Gene Patient Preferences Patient-Centered Care Patients Pharmaceutical Preparations Poverty Prospective cohort study Provider Psychosocial Factor Research Role Self Management Services Site Structure Surveys System Testing Treatment outcome United States United States National Institutes of Health Viral Viral Drug Resistance Virus acceptability and feasibility antiretroviral therapy billing data care outcomes cultural competence disparity reduction dynamic system effective intervention ethnic minority population health disparity health literacy improved individual patient innovation medical specialties medically underserved mortality patient oriented prevent programs provider factors psychosocial racial and ethnic racial and ethnic disparities racial minority resistant strain retention rate skills social determinants socioeconomic disadvantage therapy adherence therapy development transmission process treatment disparity

项目摘要

PROJECT SUMMARY Achieving high rates of retention in human immunodeficiency (HIV) care and viral suppression through antiretroviral therapy not only reduces mortality, but also is a means to reduce the incidence of HIV in affected communities because viral suppression greatly decreases communicability and prevents the transmission of resistant strains of the virus. Retention in care and viral suppression have been particularly challenging for minority populations leading to racial and ethnic disparities in HIV outcomes, including survival. Among people living with HIV infection in 2013, the percentage that was virally suppressed was only 51.5% among African Americans, 58.2% among Latinos, and 65.0% among whites. Our central hypothesis is that provider patient- centered care (PCC) factors interacting with dynamic patient psychosocial factors as well as neighborhood social determinants and medical case management site factors are influencing retention in care and viral suppression and thus contributing to health disparities. The objective of this application is to identify provider PCC factors that are moderating the effect of changes in individual characteristics on retention in care and viral suppression while considering neighborhood social determinants and medical case management site factors and to predict to what extent changes in PCC factors could improve HIV care retention and viral suppression and thus reduce health disparities. We will accomplish these objectives with a cohort study of people enrolled in the Miami-Dade County Ryan White Program 2019–2021. The Ryan White Program serves 52% of people living with HIV in the United States, in particular the medically underserved. To test our central hypothesis and achieve the objectives of this application, we propose the following four specific aims: 1) Using causal Bayesian networks, assess the moderating role of HIV provider PCC factors on the association between patient-level characteristics and retention in HIV care, viral suppression, and related health disparities cross- sectionally while accounting for neighborhood-level and medical case management site factors; 2) By means of dynamic causal Bayesian networks, assess the moderating role of HIV provider PCC factors on the association between longitudinal changes in patient-level characteristics and changes in retention in HIV care, viral suppression, and related health disparities; 3) Using dynamic causal Bayesian networks, estimate the magnitude of the expected improvement in retention in HIV care, viral suppression, and related health disparities, produced by changing provider PCC factors; and 4) Identify feasibility and acceptability issues related to potential interventions to address the most influential health disparities factors identified in aims 1–3 using expert interviews and focus group discussions with RWP providers, administrators, and patients. This research thus supports one of the Trans-NIH Plan for HIV-Related Research “cross-cutting” priorities to reduce disparities in treatment outcomes.

项目总结通过以下方式实现人类免疫缺陷(艾滋病毒)护理和病毒抑制的高保留率抗逆转录病毒治疗不仅可以降低死亡率，而且也是减少感染者感染艾滋病毒的一种手段社区，因为病毒抑制极大地降低了可传播性并防止了具有抗药性的病毒株。在护理和病毒抑制方面尤其具有挑战性少数群体导致艾滋病毒结果方面的种族和族裔差异，包括存活率。人与人之间 2013年，感染艾滋病毒的非洲人中，病毒抑制的比例仅为51.5% 美国人中，拉美裔占58.2%，白人占65.0%。我们的中心假设是供养病人- 中心护理(PCC)因素与动态的患者心理社会因素以及邻居之间的相互作用社会决定因素和医疗病例管理地点因素正在影响护理中的留存和病毒感染这是一种压迫，并因此助长了健康差距。此应用程序目标是标识提供商缓和个体特征改变对护理和病毒保留的影响的PCC因素在考虑邻里社会决定因素和医疗病例管理场地因素时的压制并预测PCC因子的变化在多大程度上可以改善HIV护理保留和病毒抑制从而缩小健康差距。我们将通过对入选人员进行队列研究来实现这些目标在迈阿密-戴德县瑞安·怀特计划2019-2021年。瑞安·怀特计划为52%的人提供服务在美国，艾滋病毒携带者，特别是医疗服务不足的人。来检验我们的中心假说为了实现本应用程序的目标，我们提出了以下四个具体目标：1)使用因果关系贝叶斯网络，评估HIV提供者PCC因素对两者之间的调节作用患者水平的特征和在艾滋病毒护理、病毒抑制和相关健康差距方面的保留分区，同时考虑邻里层面和医疗病例管理现场因素；2)通过动态因果贝叶斯网络，评估艾滋病毒提供者PCC因素对患者水平特征的纵向变化与艾滋病毒护理中保留的变化之间的关联，病毒抑制和相关的健康差异；3)使用动态因果贝叶斯网络，估计预期在艾滋病毒护理、病毒抑制和相关健康方面的改善幅度因供应商PCC因素的变化而产生的差异；以及4)确定可行性和可接受性问题与可能的干预措施有关，以解决目标1-3中确定的影响最大的健康差距因素使用专家访谈和与RWP提供者、管理人员和患者的焦点小组讨论。这因此，研究支持了艾滋病毒相关研究的跨NIH计划之一，以减少治疗结果的差异。