Clinical trials play an important role in defining optimal antiretroviral regimens, but they do not adequately reflect the experience of antiretroviral use in HIV clinical practice. Trial participants may be healthier, more motivated than typical clinic patients, and more adherent to HIV medication regimens. Delivery of HIV care in clinical trials is also more regimented and algorithm-driven than clinical practice. These differences may explain why even experienced HIV clinics have not achieved the same health outcomes as reported in clinical trials. Improving the delivery of clinical care has been identified as a national priority by the Institute of Medicine, and computer informatics are an underutilized resource. Dr. Robbins will assess factors that influence HIV-related health outcomes among over 800 patients followed at the MGH HIV clinic, design and test informatics-based provider alerts and support systems, and then use these insights to develop and pilot test an informatics-based system designed to optimize delivery of HIV clinical care.
The specific aims are:
Aim #1 : To determine and compare the effectiveness of email and electronic medical record alerts that notify patients' HIV providers of initial virologic failure or toxicity (anemia, neutropenia, thrombocytopenia, liver toxicity, and hyperlipidemia) and suboptimal clinic follow-up.
Aim #2 : To assess known and identify novel predictors of important HIV health outcomes (such as initial loss of virologic control, toxicity, and suboptimal clinic follow-up), to compare these predictors with those reported for clinical trials, and to assess their potential utility in an informatics-based clinical decision-support system.
Aim #3 : To design and test in a randomized controlled trial whether an informatics-based clinical decision-support system that combines published treatment guidelines with the findings of Aims 1 and 2 will improve HIV health outcomes, including decreased rates of virologic failure, toxicity, and suboptimal clinic follow-up, among patients followed at a large urban HIV clinic. This career development award will allow Dr. Robbins to acquire additional research skills and experience through coursework and mentoring by a diverse team of internationally recognized researchers in HIV and general medicine, allowing him to complete the transition into an independent HIV investigator.
|Robbins, Gregory K; Cohn, Susan E; Harrison, Linda J et al. (2016) Characteristics associated with virologic failure in high-risk HIV-positive participants with prior failure: a post hoc analysis of ACTG 5251. HIV Clin Trials 17:165-72|
|Psaros, Christina; Barinas, Jennifer; Robbins, Gregory K et al. (2015) Reflections on living with HIV over time: exploring the perspective of HIV-infected women over 50. Aging Ment Health 19:121-8|
|Leger, Paul D; Johnson, Daniel H; Robbins, Gregory K et al. (2014) Genome-wide association study of peripheral neuropathy with D-drug-containing regimens in AIDS Clinical Trials Group protocol 384. J Neurovirol 20:304-8|
|Zhang, Xinyan; Tierney, Camlin; Albrecht, Mary et al. (2013) Discordant associations between SLCO1B1 521T?C and plasma levels of ritonavir-boosted protease inhibitors in AIDS clinical trials group study A5146. Ther Drug Monit 35:209-16|
|Ribaudo, Heather J; Smith, Kimberly Y; Robbins, Gregory K et al. (2013) Racial differences in response to antiretroviral therapy for HIV infection: an AIDS clinical trials group (ACTG) study analysis. Clin Infect Dis 57:1607-17|
|Robbins, Gregory K; Testa, Marcia A; Su, Max et al. (2013) Site nurse-initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy, ACTG 5031: substudy of ACTG 384. HIV Clin Trials 14:235-53|
|Hulgan, Todd; Robbins, Gregory K; Kalams, Spyros A et al. (2012) T cell activation markers and African mitochondrial DNA haplogroups among non-Hispanic black participants in AIDS clinical trials group study 384. PLoS One 7:e43803|
|Haberer, Jessica E; Robbins, Gregory K; Ybarra, Michele et al. (2012) Real-time electronic adherence monitoring is feasible, comparable to unannounced pill counts, and acceptable. AIDS Behav 16:375-82|
|Psaros, Christina; Barinas, Jennifer; Robbins, Gregory K et al. (2012) Intimacy and sexual decision making: exploring the perspective of HIV positive women over 50. AIDS Patient Care STDS 26:755-60|
|Holzinger, Emily R; Grady, Benjamin; Ritchie, Marylyn D et al. (2012) Genome-wide association study of plasma efavirenz pharmacokinetics in AIDS Clinical Trials Group protocols implicates several CYP2B6 variants. Pharmacogenet Genomics 22:858-67|
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