Patients with HIV are experiencing higher than expected rates of Non-AIDS (HANA) conditions as they age that contribute to premature morbidity and mortality. An important barrier to improving these outcomes is that there are no nationally generalizable data showing how HANA conditions disease impact rates of burdensome and costly health care utilization (e.g. recurrent hospitalization), and how this changes with aging. Addressing this barrier will permit the development of evidence-based clinical interventions and facilitate policy planning. The long term goal of this research is to reduce unnecessary and costly health care utilization and institutionalization for aging persons with HIV. The objective of this application, the first step toward this long term goal, is to understand how age and selected HANA conditions (diabetes, cardiovascular disease, liver disease, pulmonary disease, and psychiatric disease) interact to affect key health care utilization events. We propose to study a 14-state, nationally representative, sample of Medicaid patients, and for those admitted to a nursing home, link the Medicaid files to nursing home Minimum Data Set (MDS). The central hypothesis of this proposal is that these HANA conditions may accelerate or accentuate frailty and functional decline, producing premature and burdensome utilization and institutionalization. The rationale for this hypothesis is that aging in persons with HIV has been associated with higher rates of chronic conditions and higher mortality than control population, but no literature that we are aware of examines the kind of care utilization that frailty and functional decline produces, or quantifies the effects of age and comorbidity on this utilization. This proposal is relevant to the NIH's mission because it seeks to reduce the burdens of illness and disability for a growing group - persons aging with HIV. This study has three Specific Aims: 1) Describe the prevalence and incidence of the selected co-morbid conditions in HIV+ persons, and describe how incidence and prevalence vary with chronologic age;2) Calculate the rate of burdensome health care utilization, nursing home use, and permanent nursing home placement as a function of chronologic age in HIV+ persons, and show how this relationship changes with the presence of the selected co-morbid conditions;and 3) Calculate the rate of functional and cognitive decline among HIV+ nursing home residents as a function of chronological age, and show how this relationship changes with the presence of the selected co-morbid conditions. This approach is innovative because we use a nationally representative sample, employ methods and approaches from health services research not previously applied to aging and HIV, link Medicaid and MDS data, and develop new analytic tools to study burdensome service utilization in Medicaid patients with HIV. The approach is significant because it can generate hypotheses about biological mechanisms in aging that can guide future work, and also because state and federal policy makers need such data to plan for future care needs. The evidence from this project will lay the groundwork for future analyses of quality and costs of care for aging patients with HIV.

Public Health Relevance

Because of the effectiveness of antiretroviral therapies (ART), patients with HIV infection are living longer. However, HIV infection and chronic ART use, in combination with the normal aging process, are producing new kinds of morbidity and disability for persons with HIV. Understanding more about how comorbid disease, frailty, and disability affect health care utilization in aging persons with HIV can contribute in important ways to improving care quality, reducing the burdens of illness and disability, and decreasing care costs.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH102202-01A1
Application #
8714607
Study Section
Special Emphasis Panel ()
Program Officer
Stoff, David M
Project Start
2014-04-07
Project End
2018-02-28
Budget Start
2014-04-07
Budget End
2015-02-28
Support Year
1
Fiscal Year
2014
Total Cost
$736,445
Indirect Cost
$273,710
Name
Brown University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912