ACCESS TO AND OUTCOMES OF HIV CARE IN THE US

该项目建议对获得艾滋病毒的机会和护理艾滋病毒的结果进行分析，其基础是1996年初在毗邻的48个美国登记了接受艾滋病毒护理的成年人的概率样本。队列的性质允许对结果进行加权，以产生对参考人群中的现象的公正估计。艾滋病毒疗法的巨大进步使长期存活成为可能。目前的建议利用这项研究的纵向性质，以及在新的治疗方法上线时的情况，评估其传播情况和传播模式对健康结果的影响。第一个目标是以行为模型中的决定因素为基础，评估与服务访问和利用相关的因素。我们将研究差异、人口差异以及诱因、促成因素和需求因素在解释差异中的作用随时间的变化。具体分析包括未满足的非医疗服务需求与接受治疗的关系、暴露群体内按种族划分的获得方式、文化适应对拉丁裔护理的影响、妇女获得治疗的问题以及门诊护理方式与接受药物的方式之间的关系。第二个目标是考察与健康相关的生活质量(HRQOL)、症状、社会支持和应对措施在接受护理的艾滋病毒人群中的进程。具体分析包括身体和角色功能以及精神健康状况的轨迹，应对和社会支持与长期的HRQOL和接受治疗的关系，不同人口亚群的HRQOL轨迹，以及对分析艾滋病毒人群HRQOL变化的替代方法的评估。第三个目标是研究艾滋病毒护理的成果。分析包括获得和使用服务的模式对死亡率的影响(将在2000年初确定)，免疫状况、病毒载量、可预防的感染、可预防的住院和高危生活质量的下降，机会性感染预防模式与结果的关系，未满足的支持性服务需求对结果的影响，以及相互竞争的需求对结果的影响。第四个目标提出了对HCSUS受试者的护理地点和主要医疗提供者的新调查的第一次分析。分析将包括国家样本提供者的特征(培训、专业知识、患者数量)，STES的特点和医生培训、经验和知识与护理质量的关系，以及结构、财务、行政和规范影响与患者护理报告和临床结果的关系。该系列产品应准确描述需要处理的因素，以优化艾滋病毒护理的机会、过程和结果。

This project proposes analyses of access to and outcomes of care for HIV, building on the HCSUS study, which enrolled a probability sample of adults receiving care for HIV in the 48 contiguous United States in early 1996. The nature of the cohort allows weighting of results to produce unbiased estimates of phenomena in the reference population. Dramatic advances in HIV therapeutics have made long-term survival possible. The current proposal takes advantage of the longitudinal nature of the study, and its fielding at the time when new treatments were coming on line, to assess their dissemination and the impact of the pattern of dissemination on health outcomes. The first Aim assesses factors associated with access to and utilization of services, building on determinants in the behavioral model. We will examine changes over time in disparities, demographic differences, and the role of predisposing, enabling and need factors in explaining disparities. Specific analyses include relationship of unmet need for nonmedical service to receipt of treatments, patterns of access by race within exposure groups, impact of acculturation on care of Latinos, access issues for women, and the relationship between patterns of ambulatory care and receipt of medications. The second Aim examines the course of health-related quality of life (HRQOL), symptoms, social support and coping among the HIV population in care. Specific analyses include trajectories of physical and role functioning and of mental health status, the relationship of coping and social support to HRQOL and receipt of therapy over time, trajectories of HRQOL in different demographic subgroups, and evaluation of alternative methods for analyzing change in HRQOL in an HIV population. The third Aim studies outcomes of HIV care. Analyses include impact of pattern of access to and use of services on mortality (to be ascertained through early 2000), decline in immune status, viral load, preventable infections, preventable hospitalizations and HRQOL, the relationship of pattern of opportunistic infection prophylaxis to outcomes, the impact of unmet need for supportive services on outcome, and the impact of competing demands on outcomes. The fourth Aim proposes the first analyses of new surveys of care sites and principal medical providers for HCSUS subjects. Analyses will include characterization of the national sample of providers (training, expertise, patient volume), the relationships of characteristics of sties and physician training, experience, and knowledge to quality of care, and relationship of structure, financial, administrative and normative influence to patient reports about care and to clinical outcomes. The series of products should provide an accurate picture of the factors that need to be addressed to optimize access, processes and outcomes of care for HIV.