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) 持续的艾滋病毒地方性传播；以及(2)未能达到重要的 部分感染艾滋病毒的人群患有抗逆转录病毒疗法。试点研究，以及 亚特兰大格雷迪健康系统的持续干预(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) 指一大群人的存在，也许等于或等于 比目前的诊所人口规模更大，他们具有以下特点 将这两个艾滋病毒问题联系在一起：他们只使用医院，而不接受 门诊护理；他们的社会和性关系网络艾滋病毒感染率很高 (的比例，而诊所接待者的比例为19%)； 许多人接受了间歇性的、不足的抗逆转录病毒治疗；他们正在 比那些去诊所的人更严重的吸毒者。我们假设这一点 可以通过他们的医疗保健寻求行为识别的群体可能是关键 既是持续的艾滋病毒地方性传播，也是最少的 可获得系统的艾滋病毒护理和HAART。为了定义和描述 这一群体，并收集信息，可以导致干预， 为了中断传输并向需要它的人提供HAART，我们建议 三组人(每组60人)的纵向研究：未出席者 (从不使用诊所服务的人)；定期就诊者(经常就诊的人 使用诊所)；以及间歇性看病者(不定期就诊的人 模式)。我们将调查人口统计，社会经济，行为， 这些人的心理和社会网络特征(特定目标 1.0)。我们将使用临床数据、联系人评估和社交网络 确定这些群体对艾滋病毒的潜在贡献的信息 传输(特定目标2.0)。我们将评估患者的心理社会接受能力 不参加使用标准心理工具的系统艾滋病毒护理 (BSI)，并将使用跨理论模型来确定他们的准备情况 致力于护理；我们将比较基因组对艾滋病毒的抵抗力水平 以评估病毒耐药性可能达到的程度，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 不出席者的待遇(具体目标3.0)。这些研究将导致 更好地了解艾滋病毒和艾滋病社区地方性的相互作用 使用HAART治疗，为干预措施将HAART带给那些 目前没有收到，并为今后的工作提供了基础 对HAART对地方性传播影响的认识

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