ACCESS TO AND OUTCOMES OF HIV CARE IN THE US

该项目拟在1996年初美国本土48个州接受艾滋病毒护理的成年人的概率抽样调查研究的基础上，对艾滋病毒护理的获得和结果进行分析。 队列的性质允许对结果进行加权，以产生对参考人群中现象的无偏估计。 艾滋病毒疗法的巨大进步使长期生存成为可能。 目前的建议利用了研究的纵向性质，以及在新的治疗方法上线时进行的实地调查，以评估其传播以及传播模式对健康结果的影响。第一个目标评估与获得和利用服务有关的因素，建立在行为模式的决定因素。 我们将研究随着时间的推移，在差异，人口差异的变化，以及在解释差异的诱发，使能和需要因素的作用。 具体的分析包括未满足的非医疗服务的需要，接受治疗，接触组内的种族访问模式，文化适应对拉丁美洲人的护理，妇女的访问问题的影响，以及门诊护理模式和接受药物之间的关系。第二个目标是研究护理中艾滋病毒感染者的健康相关生活质量、症状、社会支持和应对方式。 具体的分析包括轨迹的身体和角色功能和心理健康状况，应对和社会支持的关系，HRQOL和随着时间的推移接受治疗，HRQOL在不同的人口统计学亚组的轨迹，并评估替代方法分析变化HRQOL在艾滋病毒感染人群。 第三个目标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（到2000年初确定），免疫状态下降，病毒载量，可预防的感染，可预防的住院治疗和HRQOL，机会性感染预防模式与结果的关系，未满足的支持服务需求对结果的影响，以及竞争需求对结果的影响。 第四个目标提出了对HCSUS受试者的护理站点和主要医疗提供者的新调查的第一次分析。 分析将包括提供者的国家样本（培训，专业知识，患者数量）的特征，sties和医生培训，经验和知识的特点的关系，护理质量，结构，财务，行政和规范的影响，病人报告的关系护理和临床结果。这一系列产品应准确说明为优化艾滋病毒护理的获得、过程和成果而需要解决的因素。

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.