EFFECTS OF HEALTH LITERACY ON HEALTH DISPARITIES IN HIV CLINICAL OUTCOMES

描述（由申请人提供）：非裔美国人不成比例地受到艾滋病毒/艾滋病的影响。虽然他们只占美国人口的13%，但非洲裔美国人占被诊断患有艾滋病毒/艾滋病的人的近一半。与其他种族/族裔相比，感染艾滋病毒/艾滋病的非洲裔美国人的生存时间较短，死亡人数较多（CDC，2009年）。虽然这些差异与若干因素有关，但仍难以找到明确的根本原因。 此外，非裔美国人和其他种族/族裔少数群体的健康素养低的风险更高。非裔美国人艾滋病患者的健康素养低被认为是药物依从性差异的一个促成因素。传统定义的依从性（服药频率）的重要组成部分是药物管理或患者与提供者之间关于药物方案的“一致性”。一致性包括正确的药丸识别，理解每天的剂量/药丸数量和剂量的时间，以及准确解释警告标签，食物摄入说明。我们的研究小组发现，非裔美国人对模拟HIV方案的管理（一致性）较差，这是由低健康素养和算术能力介导的（Waldrop-Valverde et al.，2010年）。虽然已经有大量的研究对艾滋病毒患者的临床结果的依从性差的影响，相对较少的研究已经进行了一致性与艾滋病毒临床结果的关系。在其他健康状况（例如，抗凝控制、糖尿病）和弱势人群（如老年人）。然而，据我们所知，没有研究测试药物不一致是不同健康结果的原因。 在常规临床实践中，药物不一致可能会被忽视，因为依从性评估通常仅限于给药频率的测量。因此，艾滋病毒用药不一致问题的严重性尚不清楚，也不清楚它如何影响疾病进展和临床结局。我们认为，用药不一致可能是非洲裔美国人与艾滋病毒/艾滋病之间的健康差距的根本原因，并建议测试的假设，即低健康素养导致用药不一致，随后，贫穷的艾滋病毒相关的临床结果为非洲裔美国人艾滋病毒/艾滋病患者。作为我们的主要模型测试健康算术/识字介导的药物管理和临床结果的一部分，我们还将包括来自医学社会学文献的健康差异的其他患者和系统贡献者，以开发一个全面的模型，代表风险和保护因素的复杂相互作用。将在按人种/种族分层的600例HIV/AIDS患者样本中检测研究目的，并随访6个月。

DESCRIPTION (provided by applicant): African Americans are disproportionately affected by HIV/AIDS. Although they comprise only 13% of the US population, African Americans account for nearly half of the people diagnosed with HIV/AIDS. As compared to other races/ethnicities, African Americans with HIV/AIDS have shorter survival times and more deaths (CDC, 2009). Although a number of factors are associated with these disparities, clear underlying causes remain elusive. Moreover, African Americans and other racial/ethnic minorities are at heightened risk for low health literacy. Low health literacy among African American AIDS patients has been implicated as a contributing factor to disparities in medication adherence. An important component of traditionally defined adherence (pill- taking frequency), is medication management or "concordance" between patient and provider regarding a medication regimen. Concordance includes correct pill identification, comprehension of the number of doses/pills per day and the timing of doses as well as accurate interpretation of warning labels, food intake instructions. Our team found that poorer management (concordance) of a simulated HIV regimen among African Americans was mediated by low health literacy and numeracy (Waldrop-Valverde et al., 2010). Although there has been a proliferation of studies on the effects of poor adherence on clinical outcomes in HIV patients, comparatively little study has been conducted on the relationship of concordance to HIV clinical outcomes. Support for the importance of disentangling adherence from concordance is emerging among other health conditions (e.g., anticoagulation control, diabetes) and vulnerable populations (e.g. elderly). To our knowledge, however, no studies have tested medication discordance as a cause of disparate health outcomes. Medication discordance may go unnoticed in routine clinical practice since adherence assessment is often limited to only measures of dosing frequency. Therefore, the magnitude of the problem of medication discordance in HIV is not well understood nor how it may impact disease progression and clinical outcomes. We suggest that medication discordance may be a root cause of health disparities among African Americans with HIV/AIDS and propose to test the hypothesis that low health literacy leads to medication discordance and, subsequently, to poorer HIV-related clinical outcomes for African American HIV/AIDS patients. As part of our primary model testing health numeracy/literacy mediated medication management and clinical outcomes, we will also include additional patient and system contributors to health disparities from medical sociological literature to develop a comprehensive model that represents the complex interaction of risk and protective factors for those with limited health literacy. Study aims will be tested in a sample of 600 HIV/AIDS patients stratified by race/ethnicity and followed for 6 months.