Development and Validation of a Multidimensional Index of Engagement in HIV Care

描述（由申请人提供）：在美国，不到一半的艾滋病毒感染者正在接受持续治疗，只有四分之一的人无法检测到病毒载量。国家艾滋病毒/艾滋病战略优先考虑艾滋病毒感染者的护理和治疗，但显然需要提高护理保留率。艾滋病毒护理研究使用初级保健预约的出勤率来评估患者是否在护理中。虽然就诊是必要的，但这是不够的，也不一定反映病人的参与程度。参与护理是关于患者的体验以及与提供者和护理场所的互动。我们建议创建一个以患者为中心的艾滋病毒护理参与指数，该指数将在医疗保健赋权模型中建立框架，这指的是以参与、知情、协作、承诺和宽容的方式参与护理

DESCRIPTION (provided by applicant): Less than half of individuals living with HIV in the United States are receiving ongoing care, and only one- quarter have an undetectable viral load. The National HIV/AIDS Strategy prioritizes care and treatment of HIV- infected individuals, yet improvement in care retention rates is clearly needed. Research on HIV care has used attendance at primary care appointments to assess whether patients are in care. While medical visits are necessary, they are not sufficient and do not necessarily reflect a patient's level of engagement. Engagement in care is about the patient experience and interactions with providers and the care site. We propose to create a patient-centered Index of Engagement in HIV Care that will be framed within a model of Health Care Empowerment, which refers to participation in care in a way that is engaged, informed, collaborative, committed, and tolerant of uncertainty. We will create the index through a collaborative process of consensus- building with patients, providers, and research experts using iterative online Delphi surveys and in-person focus groups. We will then translate these narrative findings into scale items and develop them further through cognitive interviewing with patients. We will validate the index by administering i to a sample of patients undergoing the Patient Reported Outcomes within the CFAR Network of Integrated Clinical Systems (CNICS) and examining retrospective, cross-sectional, and prospective appointment and viral load data. The resulting Index of Engagement in HIV Care will have implications for both clinical care and research, identifying patients who are at risk fo poor clinical outcomes and providing a metric by which to develop and evaluate interventions aiming to improve engagement in care.