HAART Initiation in Behaviorally HIV-Infected Youth

描述（由申请人提供）：行为感染艾滋病毒的青少年（12-24岁）占美国已知艾滋病毒感染事件的14%，其中相当多的青少年符合开始HAART的标准。青年面临的认知和社会心理挑战使HAART治疗的成功结果变得复杂。对于青少年，治疗干预需要考虑患者的整个社会心理、生物、结构和行为背景，以确保干预措施既有效又有效。我们之前的数据显示，在一个临床队列中，有40%的符合治疗条件的hiv感染青年在研究期间的任何时候都没有接受HAART治疗，这表明可能存在患者和提供者开始HAART治疗的障碍，需要破译。这个拟议的CDA的目标是检查提供者和患者的因素，有助于提供和接受治疗的青年。这种理解对于制定和实施行为和治疗干预的临床相关试验至关重要，这些试验反映了照顾艾滋病毒感染青年的独特特点。为此，在我的指导团队的指导下，我将开展四个相互关联的项目：(1)我将进行回顾性队列分析，评估年龄对多站点HIV研究网络中符合治疗条件的患者开始HAART治疗的影响；(2)通过详细的人口统计、临床数据和acasi获得的关于心理健康、药物滥用、患者-提供者和患者-诊所相互作用的数据，我将检查HAART启动的患者预测因素。(3)我将通过半结构化访谈评估影响提供者对符合治疗条件的青年开始HAART治疗的临床决策的因素；(4)我将在一个大型的多地点提供者队列中评估提供者人口统计、培训、信念、知识和态度与符合治疗条件的年轻人开始HAART之间的关系。通过这些项目，我将检查艾滋病毒感染青年中较低的HAART起始率，并检查患者和提供者的决策和开始HAART的障碍，这将为这一人群提供有针对性的临床和生物医学干预措施。通过培训计划，我将获得对行为理论、调查方法、卫生服务研究和分析的理解，以完成拟议的项目，并为我未来的项目提供信息。结构化的指导和指导将使我成为一名跨学科的独立研究人员，能够有效地设计、研究和实施相关的、可行的、高影响的干预措施、临床算法和治疗策略，从而改善艾滋病毒感染青年的HAART启动和结果。

DESCRIPTION (provided by applicant): Behaviorally HIV-infected youth (ages 12-24) account for 14% of known incident HIV infections in the U.S., with significant numbers of youth meeting criteria for HAART initiation. Successful HAART outcomes are complicated by the cognitive and psychosocial challenges facing youth. For youth, treatment interventions need to consider the entire psychosocial, biologic, structural, and behavioral context of the patient in order to assure that interventions will prove both effective and efficacious. Our prior data has shown that 40% of HIV-infected treatment-eligible youth in a clinical cohort did not receive HAART at any point during the study period, which suggests that there are likely patient and provider barriers to HAART initiation that need to be deciphered. The goal of this proposed CDA is to examine provider and patient factors that contribute to the offering of and acceptance of treatment in youth. Such an understanding is vital to the development and implementation of clinically-relevant trials of behavioral and treatment interventions that reflect the unique features of caring for HIV-infected youth. To accomplish this, with the guidance of my mentoring team, I will embark on four inter-related projects: (1) I will perform a retrospective cohort analysis to assess the impact of age on HAART initiation for treatment-eligible patients in the multi-site HIV Research Network; (2) through a detailed examination of demographic, clinic data, and ACASI-acquired data on mental health, substance abuse, patient-provider and patient-clinic interactions, I will examine patient predictors of HAART initiation. (3) I will assess factors impacting provider clinical decision-making regarding HAART initiation in treatment-eligible youth through semi-structured interviews; and (4) I will evaluate the relationship between provider demographics, training, beliefs, knowledge, and attitudes and HAART initiation in treatment-eligible youth in a large multi-site cohort of providers. Through these projects, I will examine the lower HAART initiation rates in HIV-infected youth and examine patient and provider decision- making and barriers to HAART initiation that will inform targeted clinical and biomedical interventions for this population. Through the training plan, I will acquire the understanding of behavioral theory, survey methodology, health services research, and analysis to complete the proposed projects and to inform my future projects. The structured mentoring and guidance will enhance my development into a trans-disciplinary independent researcher capable of effectively designing, studying, and implementing relevant, feasible, high impact interventions, clinical algorithms, and treatment strategies that improve HAART initiation and outcomes for HIV-infected youth. Narrative: The numbers of U.S. youth becoming infected with HIV is increasing. HAART has many benefits; however, HIV-infected youth who meet treatment criteria have lower rates of HAART utilization than traditionally reported for adults. It is essential to understand both patient and provider decision-making regarding initiating HAART in youth in order to inform effective and acceptable targeted interventions and strategies to improve HAART initiation rates and ultimately outcomes in HIV-infected youth.