Test of an intervention to improve retention in HIV care after hospitalization

描述（由申请人提供）：医疗保健保留率低是当今人们死于艾滋病毒/艾滋病的主要原因之一。现代艾滋病毒治疗已将这种致命的感染转变为可治疗的慢性疾病。目前还没有经过验证的干预措施来更好地留住艾滋病毒初级保健人员。感染艾滋病毒的住院病人很可能得不到充分的照顾。单次或两次干预对大多数脱离护理的患者来说是必不可少的，因为任何可以被招募到多次干预的患者都可能被招募回初级保健。我们的团队一直在研究保留在艾滋病毒护理超过7年。使用信息-动机-行为技能模型作为框架，我们的数据表明，在最近被诊断为艾滋病毒感染的患者中，获得艾滋病毒初级保健的机会受到以下因素的影响：有关护理和治疗可用性的关键信息差距，与不良应对策略相关的有限动机以及对医疗保健系统的信任度低，行为技能薄弱，反映在自我效能和社会支持方面，围绕坚持艾滋病毒护理。这些因素导致在医疗保健系统中导航的能力差，并留在艾滋病毒护理。我们已经开发了一个结构化的，基于理论的，病人导师计划。病人导师计划的制定是为了提高保留到艾滋病毒初级保健，增加病人对艾滋病毒和护理系统的知识，提高自我效能，并促进积极的自我管理。在托马斯街卫生中心的一次性互动中，志愿患者导师迎接即将抵达诊所进行入诊访问的新患者，指导他们完成入诊访问并支持他们。在我们初步的准实验数据中，在入组访视期间有患者导师的患者中有88%在接下来的90天内完成了医生访视，而没有导师的患者中有78%（p<.001）。在调整基线人口统计学和临床特征后，这些影响仍然显著，并持续到摄入后90-180天。我们将在一项为期5年的随机对照试验中测试TSHC患者导师干预的有效性，该试验涉及434名在Ben Taub综合医院住院的社会经济和种族多样化的HIV感染患者。我们假设，干预措施将有意义地增加保留在艾滋病毒初级保健出院后相比，注意力控制。我们的具体目标是：1）测试患者导师干预对出院后艾滋病毒初级保健保留的有效性; 2）测试患者导师干预对次要结局的有效性，包括卫生服务使用，健康相关生活质量和临床结局; 3）确定与干预反应相关的中介因素，以及个人和系统的促进因素和艾滋病毒初级保健保留的障碍。这项研究解决了当今艾滋病毒护理中最重要的挑战之一，即，将现代艾滋病毒治疗扩大到所有有需要的人，也可能影响艾滋病毒感染者健康方面基于种族的差异。公共卫生相关性：医疗保健的保留率低是当今人们死于艾滋病毒/艾滋病的主要原因之一。我们已经制定了一个结构化的，基于理论的，病人导师计划，以提高保留到艾滋病毒的初级保健。我们将在一项为期5年的随机对照试验中测试这种患者导师干预的有效性，该试验在Ben Taub综合医院住院的400多名社会经济和种族多样化的HIV感染患者中进行。

DESCRIPTION (provided by applicant): Poor retention in medical care is one of the primary reasons people die of HIV/AIDS today. Modern HIV treatment has transformed this deadly infection into a treatable chronic condition. There are no proven interventions to better retain people in HIV primary care. Hospitalized patients with HIV infection are at high risk for poor retention in care. A single or dual session intervention is essential for most patients out of care, because any patient who could be recruited into a multi-session intervention could likely be recruited back into primary care. Our team has been researching retention in HIV care for over 7 years. Using the information-motivation-behavioral skills model as a framework, our data indicate that among patients recently diagnosed with HIV infection, access to HIV primary care is affected by critical information gaps regarding the availability of care and treatment, limited motivation related to poor coping strategies and low trust in the healthcare system, and weak behavior skills reflected in low self-efficacy and social support around adherence to HIV care. These factors result in poor ability to navigate the health care system and remain in HIV care. We have developed a structured, theory-based, Patient Mentor Program. The Patient Mentor Program was developed to improve retention into HIV primary care by increasing patient knowledge about HIV and the care system, increasing self-efficacy, and promoting active self-management. In a one- time interaction at the Thomas Street Health Center, volunteer patient mentors greet new patients who are arriving for their intake visit to the clinic, guide them through the intake visit and support them. In our preliminary, quasi-experimental data, 88% of patients who had a patient mentor during that intake visit completed a physician visit within the next 90 days, compared to 78% of patients who did not have a mentor (p<.001). These effects remained significant after adjusting for baseline demographic and clinical characteristics, and persisted into the 90-180 day interval after intake. We will test the efficacy of the TSHC patient mentor intervention in a 5-year randomized, controlled trial in 434 socio-economically and racially diverse HIV-infected patients hospitalized at Ben Taub General Hospital. We hypothesize that the intervention will meaningfully increase retention in HIV primary care after discharge compared to an attention control. Our Specific Aims are: 1) To test the efficacy of the patient mentor intervention on retention in HIV primary care after hospital discharge; 2) To test the efficacy of a patient mentor intervention on secondary outcomes that include health services use, health-related quality of life, and clinical outcomes; 3) To determine the mediating factors associated with response to the intervention, and the individual and system facilitators and barriers to retention in HIV primary care. This study addresses one of the most important challenges in HIV care today, i.e., expanding modern HIV treatment to all those in need, and may also impact race-based disparities in the health of people with HIV infection. PUBLIC HEALTH RELEVANCE: Poor retention in medical care is one of the primary reason people die of HIV/AIDS today. We have developed a structured, theory-based, Patient Mentor Program to improve retention into HIV primary care. We will test the efficacy of this patient mentor intervention in a 5-year randomized, controlled trial in more than 400 socio-economically and racially diverse HIV-infected patients hospitalized at Ben Taub General Hospital.