HIV Care Utilization: A theory-based approach to retention in care

描述（由申请人提供）：由于个人和社区水平的病毒载量负担增加，不一致的艾滋病毒医疗服务的使用与护理中的艾滋病毒阳性患者和周围社区的潜在可怕后果有关。虽然最近有大量的努力让艾滋病毒感染者（PLWH）接受治疗，并让失去治疗的PLWH重新参与治疗，但人们对HIV治疗一旦开始或重新开始的持续维持的影响因素知之甚少，尽管这一群体特别容易出现额外的并发症（如间歇性依从性引起的耐药性），并且他们提供了基于临床干预的机会之窗。拟议的工作旨在通过开发和评估基于理论的护理保留模型和简短的有针对性的干预来解决文献中的这一差距和未满足的服务相关需求，以支持那些从事护理的人的保留。我们将已建立的信息-动机-行为技能（IMB）模型应用于HIV医学中的保留，并进行了两项研究。通过识别这些心理过程中潜在的可改变的缺陷，该IMB模型被用于识别核心心理社会过程，包括信息类型、动机和行为技能，以维持长期定期使用艾滋病毒医疗保健，这些心理过程可用于通知与保留相关的干预策略。在研究1中，我们将使用基于横截面imb的护理保留措施来测试模型，并确定与内城诊所样本中护理保留相关的信息，动机和行为技能的关键水平。具体地说，我们的第一个目标是测试一个信息-动机-行为技能模型的保留艾滋病毒医疗服务在一个城市内的诊所人口。研究2将试点一项基于动机访谈的强化单次干预，该干预使用基于IMB模型的筛选器来识别基于个体模型的保留护理障碍，以定制以患者为中心的讨论，目标是坚持下一次诊所就诊，特别是针对在过去一年半的HIV护理空白的患者。这项干预将在同一队列的时间和注意力控制条件下进行评估，评估干预后六个月护理利用的客观指标，以及干预后信息、动机和行为技能的立即变化。因此，我们的第二个目标是设计、实施和评估基于临床的概念验证干预措施，旨在解决IMB模型中保留护理的核心决定因素，并促进在脆弱参与的市中心样本中保留护理。拟议的项目将对这一调查领域作出独特贡献，并对控制个人和社区一级病毒负担的可行干预方法具有实际意义。

DESCRIPTION (provided by applicant): Inconsistent use of HIV medical care has been associated with potentially dire outcomes for both the individual HIV positive patient in care and the surrounding community due to increased burden of individual- and community-level viral load. While there have been recent intense efforts to enroll people living with HIV (PLWH) into care and to re-engage PLWH lost to care, less is known about factors influencing sustained maintenance in HIV-care once initiated or re-initiated, despite this group's particular vulnerability to additional complications (such as resistance due to intermittent adherence) and the window of opportunity for clinic- based intervention that they present. The proposed work aims to address this gap in the literature and unmet service-related needs through the development and evaluation of a theory based model of retention in care and a brief targeted intervention to support retention in care for those tenuously engaged. We adapt the well- established the Information-Motivation-Behavioral Skills (IMB) model to retention in HIV medical for use in two studies. This IMB model is used to identify the core psycho-social processes in terms of the types of information, motivation, and behavior skills needed to sustain regular use of HIV medical care over time by identifying potentially modifiable deficits in these psychological processes that can be used to inform retention- related intervention strategies. In Study 1 we will use a cross-sectional IMB-based measure of retention in care to test the model and identify the critical levels of information, motivation, and behavioral skills related to retention in care within an inner-city clinic sample. Specifically, our first aim is to test an Information- Motivation- Behavioral Skills Model of retention in HIV medical care in an inner-city clinic population. Study 2 will pilot an intensive single-session motivational-interviewing based intervention that uses an IMB- model based screener to identify individual model-based barriers to retention in care to tailor the patient- centered discussion targeting adherence to the next clinic visit specifically for patients who have gapped in HIV care over the last year and a half. This intervention will be evaluated against a time and attention control condition within the same cohort on objective indices of care utilization six months post intervention, as well as on immediate post-intervention changes in information, motivation, and behavioral skills. Thus, our second aim is to design, implement, and evaluate a proof-of-concept clinic-based intervention designed to address core IMB model determinants of retention in care, and promote retention in care in a tenuously engaged inner-city sample. The proposed project will contribute uniquely to this area of inquiry and have practical implications for viable intervention approaches for controlling individual- and community-level viral burden. PUBLIC HEALTH RELEVANCE: The proposed project will test an Information Motivation Behavioral Skill model of retention in HIV medical care and evaluate a brief targeted intervention to promote retention in care via improvements in the core factors identified by this mode, which uniquely contributes to this area of research by providing a comprehensive model of retention that can be easily translated to effective intervention approaches. The pilot of the targeted theory-based intervention has implications for both extending our understanding of effective interventions for retention in care as well as for providing guidance for potential strategies to promote engagement delivered at the point of clinical care. Such efforts to enhance and sustain retention in care are necessary to achieve improved health and significant reductions in viral load critical to individual and public health.