This proposal describes a 5-year training and research program that will allow the Principal Investigator to achieve her goal of becoming an independent patient-oriented investigator with expertise in HIV health services, integrating research and public health practice. The proposed program will build on the candidate's prior experience in HIV/STD clinical and epidemiologic research by enhancing her skills in health services research and in the conduct of clinical trials involving behavioral interventions. The training plan will take advantage of an exceptional mentoring team and institutional environment that involves close collaboration between the University of Washington (UW) and the HIV/STD Control Program of Public Health-Seattle &King County (PHSKC). Research Plan - Retention in HIV care is crucial for the successful treatment of HIV infection and the prevention of HIV transmission, but there is no standard definition of retention in HIV care and little research on population-based approaches to monitoring and improving retention in HIV care.
The specific aims of this proposal are:
Aim 1) To establish a definition of inadequate retention in HIV care that is correlated with health outcomes and to identify factors that predict poor retention in care;
Aim 2) To identify healthcare system factors that facilitate retention in HIV care and evaluate the acceptability of potential clinic-based and population-based interventions to improve retention in care;
and Aim 3) To develop and conduct a pilot study of an intervention to improve retention in HIV care. We will address Aim 1 with retrospective studies of data from the UW HIV Clinical Information System and the PHSKC surveillance system and with a prospective study of persons with newly diagnosed HIV entering HIV medical care. We will address Aim 2 using qualitative individual interviews with HIV care providers and persons living with HIV/AIDS. We will design an intervention aimed at improving retention in HIV care using the results of the studies from Aims 1 and 2, and we will conduct a pilot study to assess feasibility and acceptability of the intervention (Aim 3). We will then incorporate the results of all of these studies into the design of a future trial to evaluate the effectiveness of the intervention to improve retention in HIV care. This research will lay the groundwork for a larger research program on quality HIV care that will include rigorous evaluation of interventions aimed at improving the delivery of care with consideration for cost-effectiveness.

Public Health Relevance

Ongoing HIV care is necessary for the health of persons living with (HIV/AIDS) and for preventing the transmission of HIV. This project will evaluate measures of retention in HIV care, identify factors that facilitate retention in HIV care, and develop an intervention to increase the retention of patients in HIV care.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Stirratt, Michael J
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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Khosropour, Christine M; Capizzi, Jeffrey D; Schafer, Sean D et al. (2014) Lack of association between azithromycin and death from cardiovascular causes. N Engl J Med 370:1961-2
Barbee, Lindley A; Dombrowski, Julia C; Kerani, Roxanne et al. (2014) Effect of nucleic acid amplification testing on detection of extragenital gonorrhea and chlamydial infections in men who have sex with men sexually transmitted disease clinic patients. Sex Transm Dis 41:168-72
Dombrowski, Julia C; Buskin, Susan E; Bennett, Amy et al. (2014) Use of multiple data sources and individual case investigation to refine surveillance-based estimates of the HIV care continuum. J Acquir Immune Defic Syndr 67:323-30
Khosropour, Christine M; Dombrowski, Julia C; Barbee, Lindley A et al. (2014) Comparing azithromycin and doxycycline for the treatment of rectal chlamydial infection: a retrospective cohort study. Sex Transm Dis 41:79-85
Buskin, Susan E; Kent, James B; Dombrowski, Julia C et al. (2014) Migration distorts surveillance estimates of engagement in care: results of public health investigations of persons who appear to be out of HIV care. Sex Transm Dis 41:35-40
Dombrowski, Julia C; Harrington, Robert D; Golden, Matthew R (2013) Evidence for the long-term stability of HIV transmission-associated sexual behavior after HIV diagnosis. Sex Transm Dis 40:41-5
Barbee, Lindley A; Kerani, Roxanne P; Dombrowski, Julia C et al. (2013) A retrospective comparative study of 2-drug oral and intramuscular cephalosporin treatment regimens for pharyngeal gonorrhea. Clin Infect Dis 56:1539-45
Dombrowski, Julia C; Golden, Matthew R (2013) Modernizing operations to improve efficiency and refine the role and mission of sexually transmitted infection clinics. Sex Transm Dis 40:81-4
Barbee, Lindley A; Dombrowski, Julia C (2013) Control of Neisseria gonorrhoeae in the era of evolving antimicrobial resistance. Infect Dis Clin North Am 27:723-37
Dombrowski, Julia C; Golden, Matthew R (2012) Accelerated partner therapy: a promising new partner treatment option. Sex Transm Infect 88:2-3

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