Health literacy, cognitive & social determinants of HIV appointment attendance

描述（由申请人提供）：研究表明，错过HIV门诊预约的患者更有可能出现疾病晚期、机会性感染和死亡。艾滋病毒/艾滋病对美国社会经济较低阶层的人的影响尤为严重，这些人卫生知识贫乏的风险很高。卫生知识有限的患者可能没有必要的技能，无法有效地了解并采取行动，需要保持定期的艾滋病毒护理。尽管卫生知识普及程度低与健康状况较差、住院率增加以及不坚持服用包括艾滋病毒在内的许多疾病的药物有关，但人们对其对坚持常规临床预约的影响知之甚少。此外，与艾滋病毒感染相关的认知障碍本身可能是错过预约的一个危险因素。尽管接受了高效抗逆转录病毒疗法（HAART）的治疗，但仍有相当数量的人在记忆力、信息处理速度和其他需要组织、计划和排序的高级认知功能方面存在缺陷，而这些正是预约和履行所需要的认知技能。迄今为止，没有关于识字对医疗保健利用的影响的研究考虑到认知障碍。此外，艾滋病毒感染者普遍存在的识字和认知障碍也可能影响到与护理提供者和社会网络中其他人的互动。对艾滋病毒护理提供者的满意度和社会支持都与更好的艾滋病毒预约行为有关，并可能提供保护，防止文化水平低下和认知能力低下对错过预约的潜在影响。因此，本研究对175名HIV阳性男性和女性进行了为期7个月的前瞻性随访，以确定与后来不遵守HIV门诊预约有关的因素。预约遵守情况将通过自我报告进行评估，并通过医疗记录进行核实。我们的目标如下：1)。评估健康相关信息的基线读写能力和预测HIV常规门诊就诊的神经认知能力；2）. 评估健康相关信息、神经认知能力、社会支持和医患沟通的基线素养对遵守常规HIV门诊预约的相对贡献；3)。评估健康素养和社会支持对错过艾滋病毒医疗预约的潜在调节作用。公共卫生相关性：研究表明，那些错过艾滋病毒门诊预约的人更有可能出现疾病晚期、机会性感染和死亡。错过预约也可能与艾滋病毒传播间接相关，因为病毒血症水平较高的人更有可能将病毒传染给他人。因此，确定患者在艾滋病门诊就诊时依从性差的个体特征对于制定干预措施/方案至关重要，这些干预措施/方案可以帮助患者坚持他们的预约，最大限度地发挥现有治疗的益处，并最大限度地减少病毒未来传播的可能性。

DESCRIPTION (provided by applicant): Studies have shown that patients who miss HIV clinic appointments are more likely to have advanced disease, to develop opportunistic infections and to die. HIV/AIDS disproportionately affects those in the lower socioeconomic strata of the US and these persons are at high risk for poor health literacy. Patients with limited health literacy may not have the requisite skill to effectively understand and act upon the need to maintain regular HIV care. Although low health literacy has been linked to poorer health status, increased hospitalization rates and non-adherence to medications across a number of diseases including HIV, little is known of its effects on adherence to routine clinical appointments. Furthermore, cognitive impairment associated with HIV infection itself may be a risk factor for missed appointments. Despite treatment with HAART, substantial numbers have deficits in memory, information processing speed and other higher order cognitive functions requiring organization, planning and sequencing, the very cognitive skills needed for appointment making and keeping. No studies on the effects of literacy on healthcare utilization to date have accounted for cognitive impairment. Moreover, the literacy and cognitive challenges common in persons infected with HIV may also affect interactions with care providers and others in the social network. Both satisfaction with HIV care providers and social support are linked to better appointment-keeping behavior in HIV and may confer protection against the potential effects of poor literacy and cognition on missed appointments. This study therefore proposes to prospectively identity factors associated with later non-adherence to outpatient HIV clinic appointments in a sample of 175 HIV positive men and women followed prospectively for 7 months. Appointment adherence will be assessed through self-report and verified via medical records. The following are our aims: 1). To assess the ability of baseline literacy for health related information and neurocognitive ability to predict attendance at routine HIV clinic appointments; 2). To assess the relative contribution of baseline literacy for health related information, neurocognitive ability, social support, and patient-provider communication to adherence to routine HIV clinic appointments; 3).To assess potential moderating effects between health literacy and social support on missed HIV medical appointments. PUBLIC HEALTH RELEVANCE: Studies have shown that those who miss HIV clinic appointments are more likely to have advanced disease, to develop opportunistic infections and to die. Missed appointments may also be indirectly tied to HIV transmission since persons with higher levels of viremia are more likely to transmit the virus to others. Therefore, identifying characteristics of individuals at risk for poor adherence to HIV outpatient appointments is essential for developing interventions/programs that assist patients to adhere to their appointments, maximize the benefits of available treatment, and minimize the potential for future spread of the virus.