Attitudes and Beliefs and the Steps of HIV Care

描述（由申请人提供）：高效抗逆转录病毒疗法（HAART）显著提高艾滋病毒患者的生存率。HAART在常规护理中的有效性取决于患者是否能够成功地遵循艾滋病毒护理的某些关键步骤，这些步骤包括1)获得门诊护理，2)利用护理和治疗服务，以及3)坚持护理。然而，即使在HAART时代，约40%的艾滋病毒感染者在诊断后6个月内没有接受治疗，坚持治疗仍然是各级的一个挑战。迄今为止的研究还不能跟踪患者完成艾滋病毒护理的整个步骤。因此，我们不清楚为什么患者参与护理的程度如此之低，也不清楚不充分遵循艾滋病毒护理步骤的临床和社会后果。本申请用于创新性、预备性服务研究。研究艾滋病毒护理步骤需要三个基本要素：患者和卫生保健系统相互作用的经过验证的模型，测量关键结构的经过验证的工具，以及分析这些极其复杂的数据的方法。我们将在一项前瞻性观察队列研究的背景下实现这些要素，该研究在HIV诊断时招募患者，每3个月随访一次，持续18个月。我们将实现3个目标：1)评估随着时间的推移对艾滋病疾病和护理的态度和信念的关系，并将这些态度和信念与成功遵循艾滋病毒护理步骤联系起来。2)验证一个简单的基于视觉模拟量表的工具，用于评估新开始HAART常规护理的患者对HAART的依从性。3)利用纵向数据分析技术，检验潜在增长曲线分析对态度和信念随时间变化建模的稳健性，以及非递归因果模型对HIV护理步骤模型各组成部分对健康结果的影响。这些研究将使我们能够确定改善结果的可修改因素，并针对艾滋病毒护理步骤，在该步骤中应该集中干预措施以最大限度地发挥影响。

DESCRIPTION (provided by applicant): Highly active antiretroviral therapy (HAART) dramatically improves the survival of patients with HIV. The effectiveness of HAART in routine care is determined by the success with which patients are able to follow certain crucial Steps of HIV Care, which includes 1) access outpatient care, 2) utilize care and treatment services, and 3) adhere to care. Yet even in the HAART era, about 40% of persons with HIV do not enter care within 6 months after diagnosis, and adherence remains a challenge at all levels. Studies to date have not been able to follow patients through the entire Steps of HIV Care. As a result, we do not have a clear understanding of why patients so poorly engage in care, or the clinical and societal consequences of inadequately following the Steps of HIV Care. This application is for innovative, preparatory services research. Three essential elements are needed to study the Steps of HIV Care: a validated model for the interaction of patient and health care system, validated instruments to measure key constructs, and a methodology to analyze these extremely complex data. We will achieve these elements in the context of a prospective observational cohort study of patients enrolled at the time of HIV diagnosis, followed every 3 months for 18 months. We will accomplish 3 aims: 1) Assess the relation of attitudes and beliefs about HIV disease and care over time and relate those attitudes and beliefs with success in following the Steps of HIV Care. 2) Validate a simple visual analogue scale-based instrument for assessing adherence to HAART in patients newly starting HAART in routine care. 3) Test the robustness of latent growth curve analysis for modeling changes in attitudes and beliefs overtime, and non-recursive causal modeling with longitudinal data analysis techniques for assessing the impact of each component of the Steps of HIV Care model on health outcomes. These studies will allow us to identify modifiable factors for improving outcomes, and target the Step of HIV Care where interventions should be focused to maximize impact.