Optimizing Rapid and Full Engagement in Care for Persons with Newly Diagnosed HIV

描述(由申请人提供)：疾病控制和预防中心现在建议在所有卫生保健环境中进行常规(非定向)艾滋病毒检测，包括医院急诊科(ED)和紧急护理诊所(UCC)。来自急性护理环境的艾滋病毒诊断是治疗和预防工作的主要目标人群，特别是因为医疗艾滋病毒检测举措往往服务于脆弱的城市群体，这些群体被证明因未能参与护理而面临更大的风险。然而，据估计，美国新诊断的艾滋病毒患者中有30%-50%未能在6个月内进入治疗。关于如何迅速和充分地让新近确诊的艾滋病毒患者接受护理的研究很少。此外，关于通过常规(非靶向)测试被诊断出来如何影响护理最初几个月的保留率，人们知之甚少。这项提议的目标是产生关于快速和充分参与艾滋病毒护理的决定因素的知识，并制定促进艾滋病毒护理的战略。这项研究是在一个概念理论模型的指导下进行的，该模型为测量仪器和结构化的研究计划提供了信息。对于在旧金山总医院ED/UCC通过常规(非定向)检测被诊断为艾滋病毒的患者以及在SFGH艾滋病毒诊所建立护理的患者，具体目标是：1)确定快速全面参与护理的障碍和促进者；2)确定快速全面参与艾滋病毒护理的预测因素；3)制定干预措施，促进快速全面参与艾滋病毒护理。具体目标1将通过定性方法实现。具体目标2将通过社会人口学、行为和临床变量的基线评估以及使用电子病历来跟踪预约和临床结果来实现。具体目标3将通过分析目标1和目标2的数据、相关领域的文献审查和利益攸关方的投入来实现。通过有重点的课程作业和指导培训，候选人将发展定性调查、基于队列的流行病学方法、行为理论和干预开发方面的技能，以执行这些特定目标，并为成为一名致力于缩小艾滋病毒病例识别和护理启动之间的差距的独立调查员奠定基础。 与公共健康相关：美国的艾滋病毒筛查已扩展到急诊科和紧急护理诊所等急诊医疗机构，在这些地方，无论患者就诊的原因是什么，都会为患者提供检测。关于在急性医疗环境中新诊断为艾滋病毒的患者如何建立门诊艾滋病毒护理，人们知之甚少。这项研究将有助于确定快速和充分参与艾滋病毒护理的关键因素，并制定支持这一进程的干预措施。

DESCRIPTION (provided by applicant): The Centers for Disease Control and Prevention now recommends routine (non-targeted) HIV testing in all health care settings, including hospital emergency departments (EDs) and urgent care clinics (UCCs). HIV diagnoses from acute care settings represent a key target population for treatment and prevention efforts, especially since medical HIV testing initiatives often serve vulnerable urban groups who have been shown to be at increased risk for failing to engage in care. However, an estimated 30-50% of new HIV diagnoses in the U.S. fail to enter care within 6 months. Few studies exist on how to rapidly and fully engage recently diagnosed HIV patients in care. Moreover, little is known about how being diagnosed via routine (non-targeted) testing impacts retention in the first months of care. The goals of this proposal are to generate knowledge about the determinants of rapid and full engagement in HIV care and develop strategies to promote it. This research is guided by a conceptual- theoretical model that informs measurement instruments and a structured research plan. For patients diagnosed with HIV via routine (non-targeted) testing in the San Francisco General Hospital ED/UCC and who establish care in the SFGH HIV clinic, specific aims are to: 1) Identify barriers to and facilitators of rapid full engagement in care; 2) Determine predictors of rapid full engagement in HIV care; 3) Develop an intervention to promote rapid full engagement in HIV care. Specific Aim 1 will be accomplished via qualitative methods. Specific Aim 2 will be accomplished through baseline assessment of socio-demographic, behavioral, and clinical variables and use of the electronic medical record to track appointment and clinical outcomes. Specific Aim 3 will be accomplished through analysis of data from Aims 1 & 2, a literature review of related fields, and stakeholder input. Through a focused program of coursework and mentored training, the candidate will develop the skills in qualitative inquiry, cohort-based epidemiologic approaches, behavioral theory and intervention development to execute these specific aims and lay the foundation to become an independent investigator dedicated to closing the gap between HIV case identification and care initiation. PUBLIC HEALTH RELEVANCE: HIV screening in the U.S. has expanded to acute medical settings, such as emergency departments and urgent care clinics, where patients are offered testing regardless of the reason for the visit. Little is known about how patients newly diagnosed with HIV in acute medical settings establish outpatient HIV care. This research will help identify key factors in rapid and full engagement in HIV care and develop an intervention to support this process.