PERSONS WITHOUT HAART--CHARACTERISTICS AND DETERMINANTS

临床医生和研究人员面临两个主要的艾滋病毒问题：（1） 艾滋病毒的持续地方性传播;（2）未能达到重要的 部分艾滋病毒感染者接受高效抗逆转录病毒治疗。试点研究，以及 亚特兰大格雷迪卫生系统正在进行的干预（其中包括 格雷迪医院和传染病诊所，艾滋病毒护理的主要提供者） 暗示存在一个相当大的群体，也许等于或 比目前的诊所人口规模更大， 将这两个艾滋病问题联系起来：他们只使用医院， 门诊护理;他们的社交和性网络艾滋病毒感染率很高 (64%，相比之下，在诊所就诊者的接触者中为19%）; 许多人接受了间歇性的、不充分的抗逆转录病毒治疗; 比诊所里的人更强烈的吸毒者。我们认为， 通过他们的医疗保健寻求行为可以识别的群体，可能是至关重要的 艾滋病毒的地方性传播， 获得系统的艾滋病毒护理和高效抗逆转录病毒疗法。为了定义和描述 这个群体，并收集信息，可以导致干预， 中断传输，并提供HAART那些需要它，我们建议， 对三组人（每组60人）进行的纵向研究： （从不使用诊所服务的人）;定期就诊的人（定期 使用诊所）;和间歇性出席者（那些不定期出席 模式）。我们将调查人口统计学，社会经济学，行为学， 这些人的心理和社会网络特征（具体目标 1.0）。我们将使用临床数据，接触评估和社交网络 确定这些群体对艾滋病毒的潜在贡献的信息 传播（具体目标2.0）。我们将评估社会心理接受能力， 未参加使用标准心理工具的系统性艾滋病毒护理的患者 (the BSI），并将使用跨理论模型来确定其准备情况 我们将比较基因组对艾滋病病毒的抗性水平， 在三组中评估病毒耐药性的程度（如果有的话） 在当前的地方性传播中很重要，并可能影响潜在的 治疗未参加者（具体目标3.0）。这些研究将导致 更好地了解艾滋病毒的社区流行性和 用HAART治疗，为干预措施奠定基础， 目前尚未收到，并在今后的工作中提供一个基础， 了解高效抗逆转录病毒疗法对地方性传播的影响

Two major HIV issues confront clinicians and investigators: (1) ongoing endemic transmission of HIV; and (2) failure to reach an important portion of the HIV-infected population with HAART. Pilot studies, and an ongoing intervention in Atlanta at the Grady Health System (which includes Grady Hospital and the Infectious Disease Clinic, a major provider of HIV care) suggest the presence of a substantial group of people, perhaps equal to or greater in size than the current clinic population, who have characteristics that link these two HIV issues: they use only the hospital and receive no outpatient care; their social and sexual networks have a high prevalence of HIV (64 percent, compared to 19 percent among the contacts of clinic attenders); many have received episodic, inadequate antiretroviral therapy; and they are more intense drug users than are those attending the clinic. We posit that this group, identifiable through their health care seeking behavior, may be critical for both ongoing endemic transmission of HIV, and are the persons least reachable for systematic HIV care and HAART. In order to define and describe this group, and collect information that can lead to interventions that can interrupt transmission and provide HAART to those requiring it, we propose to a longitudinal study of three groups of persons (60 in each group): Nonattenders (those who never use clinic services); Regular Attenders (those who regularly use the clinic); and Intermittent Attenders (those with irregular attendance patterns). We will investigate the demographic, socioeconomic, behavioral, psychological and social network characteristics of these persons (specific aim 1.0). We will use clinical data, contact evaluation, and social network information to determine the potential contribution of these groups to HIV transmission (specific aim 2.0). We will assess the psychosocial receptivity of Nonattenders to systematic HIV care using a standard psychologic instrument (the BSI) and will use the Transtheoretical Model to identify their readiness to commit to care; and we will compare the level of genomic resistance to HIV in the three groups to assess the degree, if any, to which viral resistance may be important in current endemic transmission, and may influence the potential treatment of Nonattenders (specific aim 3.0). These studies will lead to a better understanding of the interaction of community endemicity of HIV and treatment with HAART, set the stage for interventions to bring HAART to those not currently receiving it, and provide a basis, in future work for an understanding of the impact of HAART on endemic transmission