HAART Initiation in Behaviorally HIV-Infected Youth

描述（由申请人提供）：在美国，行为上感染艾滋病毒的青年（12-24岁）占已知艾滋病毒感染事件的14%，大量青年符合HAART启动标准。成功的HAART结果因青年面临的认知和心理社会挑战而复杂化。对于青少年，治疗干预措施需要考虑患者的整个心理社会，生物，结构和行为背景，以确保干预措施将被证明是有效的和有效的。我们之前的数据显示，在临床队列中，40%的艾滋病毒感染的治疗合格青年在研究期间的任何时候都没有接受HAART，这表明可能存在患者和提供者对HAART启动的障碍，需要破译。这一拟议的CDA的目标是检查提供者和病人的因素，有助于提供和接受治疗的青年。这种理解是至关重要的发展和实施的临床相关的行为和治疗干预试验，反映了独特的特点，照顾艾滋病毒感染的青年。为了实现这一目标，在我的指导团队的指导下，我将着手四个相互关联的项目：（1）我将进行回顾性队列分析，以评估年龄对多站点HIV研究网络中符合治疗条件的患者开始HAART治疗的影响;（2）通过详细检查人口统计学、临床数据和ACASI获得的关于精神健康、药物滥用、患者-提供者和患者-诊所的相互作用，我将研究患者的预测HAART启动。(3)我将通过半结构化访谈评估影响提供者临床决策的因素，这些决策是关于在符合治疗条件的青少年中启动HAART的;（4）我将评估提供者人口统计学、培训、信念、知识和态度与在一个大型多站点队列中在符合治疗条件的青少年中启动HAART之间的关系。通过这些项目，我将研究艾滋病毒感染青年的HAART启动率较低，并研究患者和提供者的决策和HAART启动的障碍，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促进我发展成为一个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，高影响力的干预措施，临床算法和治疗策略，改善HAART启动和艾滋病毒感染青年的结果。 简介：美国年轻人感染艾滋病毒的人数正在增加。HAART有很多好处;然而，符合治疗标准艾滋病毒感染青年利用高效抗逆转录病毒疗法的比率低于传统上报告的成年人。必须了解患者和提供者关于在青年中启动HAART的决策，以便为有效和可接受的有针对性的干预措施和战略提供信息，以提高HAART启动率并最终改善感染艾滋病毒的青年的结局。

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.