Understanding antiretroviral adherence changes from the community to the nursing home

项目摘要 在疗养院(NH)感染艾滋病毒的居民中，抗逆转录病毒治疗(ART)的依从性不佳； 21%的HIV携带者没有在NH中学习艺术，这与87.5%的持有率形成对比 在社区居住的携带艾滋病毒的老年人中。ART保持病毒抑制，防止病情恶化 慢性疾病和早期死亡，以及停止ART的指征很少。因此，最佳的艺术坚持 在NH环境中，只有了解索赔中记录的促进者和障碍才能实现 并被感染艾滋病毒的老年人察觉到。这项混合方法研究将在治疗期间评估ART的依从性 三个目标：目标1将确定个人级别、NH级别、 与社会经济多元化的医疗保险和医疗补助特别项目中抗逆转录病毒治疗依从性变化相关的因素 需要计划(SNP)索赔。AIM 2将评估长期居住在NH的艾滋病毒携带者的看法和经历 通过定性访谈和目标3，我们将检验与艺术相关的和谐和不和谐因素 通过对目标1和2进行三角测量来遵守。定量分析将使用两个数据库1)Medicare 5% 增强样本；2)纽约一家医疗补助艾滋病毒SNP的索赔。Logistic回归与线性回归 将检验ART依从性与前6个月相比的变化 达到NH长期居留状态后的前三个月(1年连续入学)。后来， 定性访谈将集中在50岁以上艾滋病毒携带者的观点和经历。 当他们是长期居住在NH的居民时，他们对促进者和坚持艺术的障碍感到担忧。已招聘 通过两个组织，访谈将被半结构化，并使用NVivo软件进行分析 通过扎根的理论分析建立归纳和演绎的理论，直到达到主题饱和。 使用协调和启动技术的三角测量将解决量化和启动之间的不一致 定性的发现。结果将提供行政索赔数据之外的细微差别，因为它包括 决定因素和人生经历(例如，住房不稳定)。这项工作将把梅博士的技能扩展到 包括医疗补助SNP数据、定性和混合方法研究。她将得到四位共同导师的支持 在老年病学、二次数据、定性和混合方法研究以及卫生政策方面拥有专业知识， 除了通过东北大学和相关资源进行正式培训外。这份职业发展 该奖项将完善梅博士努力研究影响人群的技能，从而帮助她成为 她是艾滋病毒和老龄化领域的独立研究员和领导者。这也将是未来R01研究的基础 分析在NH中与坚持抗逆转录病毒治疗相关的医疗利用和健康结果。

Project Summary Antiretroviral therapy (ART) adherence among nursing home (NH) residents with HIV is less than optimal; in the literature 21% of people with HIV had no ART from their NH, which is in contrast to the 87.5% adherence among community dwelling older people with HIV. ART maintains viral suppression, prevents worsening of chronic conditions and early mortality, and stopping ART is rarely indicated. Therefore optimal ART adherence in the NH setting can only be achieved by understanding facilitators and barriers both documented in claims and perceived by older people with HIV. This mixed methods study will assess ART adherence during the community-to-long-stay-NH-transition period in three aims: Aim 1 will identify person-level, and NH-level, factors associated with changes in ART adherence in socioeconomically diverse Medicare and Medicaid special needs plan (SNP) claims. Aim 2 will assess perceptions and experiences of long-stay NH residents with HIV through qualitative interviews and Aim 3 will examine concordant and discordant factors associated with ART adherence by triangulation of Aims 1 and 2. Quantitative analyses will use two databases 1) Medicare 5% enhanced sample; 2) claims from a New York City-based Medicaid HIV SNP. Logistic and linear regression with generalized estimating equations will examine the change in ART adherence from the 6 months prior, to the first three months after achieving NH long-stay status (1-year continuous enrollment). Subsequently, qualitative interviews will focus on perspectives and experiences of people living with HIV aged 50+ with regard to facilitators and barriers to ART adherence while they were a long-stay NH residents. Recruited through two organizations, interviews will be semi-structured and analyzed with NVivo software using inductive and deductive theory building through grounded theory analysis and until thematic saturation is met. Triangulation using reconciliation and initiation techniques will address discordance between quantitative and qualitative findings. The results will provide nuance beyond administrative claims data by including social determinants and life course experiences (e.g., housing instability). This work will expand Dr Mui’s skills to include Medicaid SNP data, qualitative and mixed-methods research. She will be supported by four co-mentors with expertise in geriatrics, secondary data and qualitative and mixed-methods research, and health policy, in addition to formal training through Northeastern University and related resources. This career development award will complete Dr. Mui’s skills for researching hard to reach populations thereby helping establish her as an independent researcher and leader in HIV and aging. It will also be foundational to future R01 research to analyze healthcare utilization and health outcomes associated with ART adherence in the NH.