Understanding the Care-Seeking Behavior of HIV Positive Persons in North Carolina

描述(申请人提供)：在艾滋病毒感染者中及早提出医疗护理可以提高生命长度和质量，减少高危行为。尽管有这些好处，许多成年人在感染艾滋病毒的后期才接受护理，抵消了及时获得艾滋病毒服务的好处和错失降低风险的机会。因此，将艾滋病毒阳性者与高质量的护理和预防服务联系起来已被确定为美国疾病控制和预防中心(CDC)的优先事项。这项提案的目的是检查影响北卡罗来纳州艾滋病毒检测和寻求护理行为的结构性和个体因素。在我们的第一个目标中，我们将描述在北卡罗来纳大学(UNC)传染病诊所(ID)接受护理的HIV阳性患者中，感知到的社会支持对延迟就医的影响。这项二次分析将利用北卡罗来纳州大学艾滋病研究中心(CFAR)的临床社会人口调查和临床和研究数据库中的数据。社会支持将用修改后的MOS社会支持调查量表进行量化，并进入Cox比例风险模型，以确定其对检测呈阳性后延误寻求护理的影响。在第二个目标中，我们建议进行一项定性研究，以描述在北卡罗来纳大学ID诊所就诊的患有临床晚期疾病的艾滋病毒感染者对艾滋病毒护理的态度和信念。我们计划对前一年首次就诊时接受免疫抑制治疗的HIV感染者进行半结构化的个人定性访谈，定义为HAART治疗的适应症(CD4+T淋巴细胞计数和350细胞/mm3)。概念框架和访谈工具将根据健康信念模型的结构进行开发。疾控中心最近发布的检测建议旨在将艾滋病毒检测纳入常规医疗服务。因此，有必要全面了解新诊断的患者如何、何时和为什么进入护理，以确保新的筛查指南产生最大益处。为此，这项研究的发现将阐明早期艾滋病毒检测和医疗保健的障碍和促进因素。我们的发现将对艾滋病毒/艾滋病转诊系统的评估、检测后咨询信息和衔接病例管理计划产生直接的公共卫生影响。

DESCRIPTION (provided by applicant): Early presentation for medical care among HIV infected persons can improve the length and quality of life and reduce high-risk behavior. Despite these benefits, many adults enter care late in the course of HIV infection, countering the benefits of timely access to HIV services and missing opportunities for risk reduction. Linking HIV positive persons to high-quality care and prevention services has consequently been identified as a priority of the U.S. Centers for Disease Control and Prevention (CDC). The objective of this proposal is to examine the structural and individual factors that influence HIV testing and care-seeking behavior in North Carolina. In our first Aim, we will describe the effect of perceived social support on late presentation to medical care among HIV positive persons receiving care at the University of North Carolina (UNC) Infectious Disease (ID) Clinic. This secondary analysis will utilize data from the Clinical Socio-Demographic Survey and the Clinical and Research Database at the Center for AIDS Research (CFAR) at UNC. Social support will be quantified with a modified MOS Social Support Survey Scale and entered into a Cox proportional hazard model to determine its effect on delays seeking care after testing positive. In our second Aim, we propose a qualitative study to describe the attitudes and beliefs about HIV care among HIV-infected persons attending the UNC ID clinic who presented with clinically advanced illness. We plan to conduct semi-structured, individual qualitative interviews of HIV-infected persons who presented to care in the previous year with immunosuppression at their initial visit, defined as an indication for HAART therapy (CD4+ T-lymphocyte cell count <350 cells/mm3). The conceptual framework and interview instrument will be developed with constructs from the Health Belief Model. Recent testing recommendations issued by the CDC aim to incorporate HIV testing into routine medical care. A comprehensive understanding of how, when, and why newly diagnosed individuals enter care is therefore necessary to ensure that the new screening guidelines yield their maximum benefit. Towards this end, the findings from this research will elucidate barriers and facilitators to early HIV testing and medical care. Our findings will have direct public health implications for the evaluation of the HIV/AIDS referral system, post- test counseling messages, and bridging case management programs.