Highly active antiretroviral therapy (HAART) dramatically improves the survival of patients with HIV. The effectiveness of HAART in routine care is determined by the success with which patients are able to follow certain crucial Steps of HIV Care, which includes 1) access outpatient care, 2) utilize care and treatment services, and 3) adhere to care. Yet even in the HAART era, about 40% of persons with HIV do not enter care within 6 months after diagnosis, and adherence remains a challenge at all levels. Studies to date have not been able to follow patients through the entire Steps of HIV Care. As a result, we do not have a clear understanding of why patients so poorly engage in care, or the clinical and societal consequences of inadequately following the Steps of HIV Care. This application is for innovative, preparatory services research. Three essential elements are needed to study the Steps of HIV Care: a validated model for the interaction of patient and health care system, validated instruments to measure key constructs, and a methodology to analyze these extremely complex data. We will achieve these elements in the context of a prospective observational cohort study of patients enrolled at the time of HIV diagnosis, followed every 3 months for 18 months. We will accomplish 3 aims: 1) Assess the relation of attitudes and beliefs about HIV disease and care over time and relate those attitudes and beliefs with success in following the Steps of HIV Care. 2) Validate a simple visual analogue scale-based instrument for assessing adherence to HAART in patients newly starting HAART in routine care. 3) Test the robustness of latent growth curve analysis for modeling changes in attitudes and beliefs overtime, and non-recursive causal modeling with longitudinal data analysis techniques for assessing the impact of each component of the Steps of HIV Care model on health outcomes. These studies will allow us to identify modifiable factors for improving outcomes, and target the Step of HIV Care where interventions should be focused to maximize impact.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
5R34MH074360-03
Application #
7321073
Study Section
Special Emphasis Panel (ZMH1-ERB-C (12))
Program Officer
Stirratt, Michael J
Project Start
2005-12-01
Project End
2009-11-30
Budget Start
2007-12-01
Budget End
2009-11-30
Support Year
3
Fiscal Year
2008
Total Cost
$254,888
Indirect Cost
Name
Baylor College of Medicine
Department
Pediatrics
Type
Schools of Medicine
DUNS #
051113330
City
Houston
State
TX
Country
United States
Zip Code
77030
Graham, James L; Shahani, Lokesh; Grimes, Richard M et al. (2015) The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care. AIDS Patient Care STDS 29:661-7
Kelly, J Daniel; Hartman, Christine; Graham, James et al. (2014) Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study. J Assoc Nurses AIDS Care 25:405-13
Giordano, Thomas P; Rodriguez, Sonia; Zhang, Hong et al. (2013) Effect of a clinic-wide social marketing campaign to improve adherence to antiretroviral therapy for HIV infection. AIDS Behav 17:104-12
Graham, James L; Grimes, Richard M; Slomka, Jacquelyn et al. (2013) The role of trust in delayed HIV diagnosis in a diverse, urban population. AIDS Behav 17:266-73
Buscher, April; Latini, David M; Hartman, Christine et al. (2013) Utility of a partner communication scale and a personal meaning scale in newly diagnosed HIV-infected persons. J Assoc Nurses AIDS Care 24:126-34
Buscher, A; Hartman, C; Kallen, M A et al. (2012) Impact of antiretroviral dosing frequency and pill burden on adherence among newly diagnosed, antiretroviral-naive HIV patients. Int J STD AIDS 23:351-5
Shahani, Lokesh; Hartman, Christine; Troisi, Cathy et al. (2012) Causes of hospitalization and perceived access to care among persons newly diagnosed with HIV infection: implications for HIV testing programs. AIDS Patient Care STDS 26:81-6
Bhatia, Ramona; Hartman, Christine; Kallen, Michael A et al. (2011) Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: results from the Steps Study. AIDS Behav 15:1161-70
Buscher, April; Hartman, Christine; Kallen, Michael A et al. (2011) Validity of self-report measures in assessing antiretroviral adherence of newly diagnosed, HAART-naive, HIV patients. HIV Clin Trials 12:244-54
Graham, James L; Giordano, Thomas P; Grimes, Richard M et al. (2010) Influence of trust on HIV diagnosis and care practices: a literature review. J Int Assoc Physicians AIDS Care (Chic) 9:346-52

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