HIV Care Utilization: A theory-based approach to retention in care

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DESCRIPTION (provided by applicant): Inconsistent use of HIV medical care has been associated with potentially dire outcomes for both the individual HIV positive patient in care and the surrounding community due to increased burden of individual- and community-level viral load. While there have been recent intense efforts to enroll people living with HIV (PLWH) into care and to re-engage PLWH lost to care, less is known about factors influencing sustained maintenance in HIV-care once initiated or re-initiated, despite this group's particular vulnerability to additional complications (such as resistance due to intermittent adherence) and the window of opportunity for clinic- based intervention that they present. The proposed work aims to address this gap in the literature and unmet service-related needs through the development and evaluation of a theory based model of retention in care and a brief targeted intervention to support retention in care for those tenuously engaged. We adapt the well- established the Information-Motivation-Behavioral Skills (IMB) model to retention in HIV medical for use in two studies. This IMB model is used to identify the core psycho-social processes in terms of the types of information, motivation, and behavior skills needed to sustain regular use of HIV medical care over time by identifying potentially modifiable deficits in these psychological processes that can be used to inform retention- related intervention strategies. In Study 1 we will use a cross-sectional IMB-based measure of retention in care to test the model and identify the critical levels of information, motivation, and behavioral skills related to retention in care within an inner-city clinic sample. Specifically, our first aim is to test an Information- Motivation- Behavioral Skills Model of retention in HIV medical care in an inner-city clinic population. Study 2 will pilot an intensive single-session motivational-interviewing based intervention that uses an IMB- model based screener to identify individual model-based barriers to retention in care to tailor the patient- centered discussion targeting adherence to the next clinic visit specifically for patients who have gapped in HIV care over the last year and a half. This intervention will be evaluated against a time and attention control condition within the same cohort on objective indices of care utilization six months post intervention, as well as on immediate post-intervention changes in information, motivation, and behavioral skills. Thus, our second aim is to design, implement, and evaluate a proof-of-concept clinic-based intervention designed to address core IMB model determinants of retention in care, and promote retention in care in a tenuously engaged inner-city sample. The proposed project will contribute uniquely to this area of inquiry and have practical implications for viable intervention approaches for controlling individual- and community-level viral burden. PUBLIC HEALTH RELEVANCE: The proposed project will test an Information Motivation Behavioral Skill model of retention in HIV medical care and evaluate a brief targeted intervention to promote retention in care via improvements in the core factors identified by this mode, which uniquely contributes to this area of research by providing a comprehensive model of retention that can be easily translated to effective intervention approaches. The pilot of the targeted theory-based intervention has implications for both extending our understanding of effective interventions for retention in care as well as for providing guidance for potential strategies to promote engagement delivered at the point of clinical care. Such efforts to enhance and sustain retention in care are necessary to achieve improved health and significant reductions in viral load critical to individual and public health.