EFFECTS OF HEALTH LITERACY ON HEALTH DISPARITIES IN HIV CLINICAL OUTCOMES

描述（由申请人提供）：非裔美国人受到艾滋病毒/艾滋病的影响不成比例。尽管非洲裔美国人只占美国人口的13%，但他们却占了被诊断患有艾滋病毒/艾滋病的人的近一半。与其他种族/族裔相比，感染艾滋病毒/艾滋病的非洲裔美国人的生存时间更短，死亡率更高（疾病预防控制中心，2009年）。虽然有许多因素与这些差异有关，但明确的根本原因仍然难以捉摸。此外，非裔美国人和其他种族/族裔少数群体卫生知识普及程度低的风险更高。非裔美国人艾滋病患者的低健康素养被认为是导致药物依从性差异的一个因素。传统定义的依从性（服药频率）的一个重要组成部分是药物管理或患者和提供者之间关于药物治疗方案的“一致性”。一致性包括正确的药丸识别，理解每天的剂量/药丸数量和剂量时间，以及准确解释警告标签，食物摄入说明。我们的团队发现，非裔美国人对模拟艾滋病毒方案的较差管理（一致性）是由较低的健康素养和计算能力介导的（Waldrop-Valverde等人，2010）。尽管关于依从性差对HIV患者临床结局影响的研究已经大量出现，但关于依从性与HIV临床结局关系的研究相对较少。在其他健康状况（如抗凝控制、糖尿病）和弱势群体（如老年人）中，越来越多的人支持将依从性与一致性区分开来的重要性。然而，据我们所知，没有研究测试过药物不一致是导致不同健康结果的原因。由于依从性评估通常仅限于剂量频率的测量，因此在常规临床实践中，药物不一致可能被忽视。因此，艾滋病毒药物不一致问题的严重程度尚不清楚，也不清楚它如何影响疾病进展和临床结果。我们认为，药物不一致可能是非洲裔美国人艾滋病毒/艾滋病患者健康差异的根本原因，并建议检验低健康素养导致药物不一致，随后导致非洲裔美国人艾滋病毒/艾滋病患者与艾滋病毒相关的临床结果较差的假设。作为我们测试健康算术/读写能力介导的药物管理和临床结果的主要模型的一部分，我们还将纳入医学社会学文献中导致健康差异的其他患者和系统贡献者，以开发一个综合模型，该模型代表了健康读写能力有限的人的风险因素和保护因素的复杂相互作用。研究目标将在按种族/民族分层的600名艾滋病毒/艾滋病患者样本中进行测试，并随访6个月。

DESCRIPTION (provided by applicant): African Americans are disproportionately affected by HIV/AIDS. Although they comprise only 13% of the US population, African Americans account for nearly half of the people diagnosed with HIV/AIDS. As compared to other races/ethnicities, African Americans with HIV/AIDS have shorter survival times and more deaths (CDC, 2009). Although a number of factors are associated with these disparities, clear underlying causes remain elusive. Moreover, African Americans and other racial/ethnic minorities are at heightened risk for low health literacy. Low health literacy among African American AIDS patients has been implicated as a contributing factor to disparities in medication adherence. An important component of traditionally defined adherence (pill- taking frequency), is medication management or "concordance" between patient and provider regarding a medication regimen. Concordance includes correct pill identification, comprehension of the number of doses/pills per day and the timing of doses as well as accurate interpretation of warning labels, food intake instructions. Our team found that poorer management (concordance) of a simulated HIV regimen among African Americans was mediated by low health literacy and numeracy (Waldrop-Valverde et al., 2010). Although there has been a proliferation of studies on the effects of poor adherence on clinical outcomes in HIV patients, comparatively little study has been conducted on the relationship of concordance to HIV clinical outcomes. Support for the importance of disentangling adherence from concordance is emerging among other health conditions (e.g., anticoagulation control, diabetes) and vulnerable populations (e.g. elderly). To our knowledge, however, no studies have tested medication discordance as a cause of disparate health outcomes. Medication discordance may go unnoticed in routine clinical practice since adherence assessment is often limited to only measures of dosing frequency. Therefore, the magnitude of the problem of medication discordance in HIV is not well understood nor how it may impact disease progression and clinical outcomes. We suggest that medication discordance may be a root cause of health disparities among African Americans with HIV/AIDS and propose to test the hypothesis that low health literacy leads to medication discordance and, subsequently, to poorer HIV-related clinical outcomes for African American HIV/AIDS patients. As part of our primary model testing health numeracy/literacy mediated medication management and clinical outcomes, we will also include additional patient and system contributors to health disparities from medical sociological literature to develop a comprehensive model that represents the complex interaction of risk and protective factors for those with limited health literacy. Study aims will be tested in a sample of 600 HIV/AIDS patients stratified by race/ethnicity and followed for 6 months. PUBLIC HEALTH RELEVANCE: Although a number of studies have examined underlying causes and associated risks for disparate disease outcomes among African Americans, far fewer studies have investigated the role of health literacy and specific health-promoting behaviors on health disparities, within the context of broader social, structural and economic realities. Through its innovative approach, this study will demonstrate the effect of poor functional health literacy on disparate health outcomes and improve conceptual knowledge of health literacy in relation to other individual and contextual variables that also shape disparities. Eliminating health disparities is a primary goal of the DHHS and this highly significant study will directly impact efforts to improve parity among our most vulnerable populations.