Test of an intervention to improve retention in HIV care after hospitalization

描述(由申请人提供)：医疗保留率低是当今人们死于艾滋病毒/艾滋病的主要原因之一。现代艾滋病毒治疗已经将这种致命的感染转变为一种可治疗的慢性疾病。没有得到证实的干预措施可以更好地将人们留在艾滋病毒初级护理中。感染艾滋病毒的住院患者因护理保留不佳而面临高风险。对于大多数脱离护理的患者来说，单疗程或双疗程干预是必不可少的，因为任何可以被招募到多疗程干预中的患者都可能被招募回初级保健。我们的团队已经在艾滋病护理中研究留存超过7年了。以信息-动机-行为技能模型为框架，我们的数据表明，在最近被诊断为艾滋病毒感染的患者中，获得艾滋病毒初级保健的机会受到以下因素的影响：关于护理和治疗的可获得性的关键信息差距；与不良应对策略和对卫生保健系统的低信任有关的有限动机；以及行为技能薄弱，反映在对艾滋病毒护理的低自我效能和社会支持上。这些因素导致在卫生保健系统中导航和继续接受艾滋病毒护理的能力较差。我们已经制定了一个有组织的、基于理论的、耐心的导师计划。制定患者导师计划是为了通过增加患者对艾滋病毒和护理系统的了解、提高自我效能和促进积极的自我管理来提高对艾滋病毒初级护理的保留。在托马斯街健康中心的一次一次性互动中，志愿患者导师向即将到达诊所进行入院探视的新患者打招呼，引导他们完成入院探视并支持他们。在我们初步的准实验数据中，在入院就诊期间有患者导师的患者中，88%的患者在接下来的90天内完成了内科就诊，而没有导师的患者中这一比例为78%(p&lt；.001)。在调整了基线人口统计和临床特征后，这些影响仍然显著，并持续到服药后90-180天的间隔。我们将在一项为期5年的随机对照试验中测试TSHC患者导师干预的有效性，该试验在本陶布综合医院住院的434名社会经济和种族多样化的艾滋病毒感染患者中进行。我们假设，与注意力控制相比，干预措施将有意义地增加出院后艾滋病毒初级护理的保留率。我们的具体目标是：1)测试患者导师干预对出院后保留HIV初级护理的有效性；2)测试患者导师干预对二次结果的有效性，包括医疗服务使用、与健康相关的生活质量和临床结果；3)确定与干预反应相关的中介因素，以及个人和系统促进者以及保留HIV初级护理的障碍。这项研究解决了当今艾滋病毒护理中最重要的挑战之一，即将现代艾滋病毒治疗扩大到所有有需要的人，并可能影响艾滋病毒感染者健康方面基于种族的差异。公共卫生相关性：医疗保健保留率低是当今人们死于艾滋病毒/艾滋病的主要原因之一。我们已经制定了一个结构化的、以理论为基础的患者导师计划，以提高艾滋病毒初级护理的保留率。我们将在一项为期5年的随机对照试验中，在本陶布综合医院住院的400多名不同社会经济和种族的艾滋病毒感染患者中测试这种患者导师干预的有效性。

DESCRIPTION (provided by applicant): Poor retention in medical care is one of the primary reasons people die of HIV/AIDS today. Modern HIV treatment has transformed this deadly infection into a treatable chronic condition. There are no proven interventions to better retain people in HIV primary care. Hospitalized patients with HIV infection are at high risk for poor retention in care. A single or dual session intervention is essential for most patients out of care, because any patient who could be recruited into a multi-session intervention could likely be recruited back into primary care. Our team has been researching retention in HIV care for over 7 years. Using the information-motivation-behavioral skills model as a framework, our data indicate that among patients recently diagnosed with HIV infection, access to HIV primary care is affected by critical information gaps regarding the availability of care and treatment, limited motivation related to poor coping strategies and low trust in the healthcare system, and weak behavior skills reflected in low self-efficacy and social support around adherence to HIV care. These factors result in poor ability to navigate the health care system and remain in HIV care. We have developed a structured, theory-based, Patient Mentor Program. The Patient Mentor Program was developed to improve retention into HIV primary care by increasing patient knowledge about HIV and the care system, increasing self-efficacy, and promoting active self-management. In a one- time interaction at the Thomas Street Health Center, volunteer patient mentors greet new patients who are arriving for their intake visit to the clinic, guide them through the intake visit and support them. In our preliminary, quasi-experimental data, 88% of patients who had a patient mentor during that intake visit completed a physician visit within the next 90 days, compared to 78% of patients who did not have a mentor (p<.001). These effects remained significant after adjusting for baseline demographic and clinical characteristics, and persisted into the 90-180 day interval after intake. We will test the efficacy of the TSHC patient mentor intervention in a 5-year randomized, controlled trial in 434 socio-economically and racially diverse HIV-infected patients hospitalized at Ben Taub General Hospital. We hypothesize that the intervention will meaningfully increase retention in HIV primary care after discharge compared to an attention control. Our Specific Aims are: 1) To test the efficacy of the patient mentor intervention on retention in HIV primary care after hospital discharge; 2) To test the efficacy of a patient mentor intervention on secondary outcomes that include health services use, health-related quality of life, and clinical outcomes; 3) To determine the mediating factors associated with response to the intervention, and the individual and system facilitators and barriers to retention in HIV primary care. This study addresses one of the most important challenges in HIV care today, i.e., expanding modern HIV treatment to all those in need, and may also impact race-based disparities in the health of people with HIV infection. PUBLIC HEALTH RELEVANCE: Poor retention in medical care is one of the primary reason people die of HIV/AIDS today. We have developed a structured, theory-based, Patient Mentor Program to improve retention into HIV primary care. We will test the efficacy of this patient mentor intervention in a 5-year randomized, controlled trial in more than 400 socio-economically and racially diverse HIV-infected patients hospitalized at Ben Taub General Hospital.