CANDIDATE: Dr. Gardner is finishing his research fellowship in infectious diseases at the University of Colorado Health Sciences Center and Denver Public Health. He plans a career as an independent investigator, educator, and clinician in academic infectious diseases. Dr. Gardner's research career development plan includes obtaining an M.S.P.H. degree. He will obtain additional education in behavioral and qualitative research, and questionnaire design. ENVIRONMENT: The research will be conducted at Denver Health, a major care provider for HIV-infected persons in Denver, Colorado. The mentor and co-mentors have extensive experience in epidemiological and clinical research and statistical analysis, have competed successfully for independent funding, and have trained successful researchers and clinicians. BACKGROUND: Antiretroviral adherence has been studied for over 10 years, but generally using a single summary statistic (percent adherence) to summarize adherence behavior. We hypothesize that specific patterns of nonadherence - selective drug taking, frequent missed doses, prolonged periods of time off therapy - can be identified with more detailed study of adherence behavior. A deeper understanding of nonadherence may lead to the development of targeted and durable adherence interventions. The cost of some adherence interventions may be a barrier to their implementation, but the costs associated with poor adherence have not been well studied.
SPECIFIC AIMS : 1) to examine pharmacy refill data to acquire a detailed understanding of patterns of nonadherence to antiretrovirals in an unselected clinic population, 2) to apply hypotheses generated through retrospective analysis to prospectively obtained data from clinical trials, 3) to understand the behaviors and system-level barriers which bring about different patterns of pharmacy refills, and 4) to assess the association of antiretroviral adherence with utilization and costs of health care.

Public Health Relevance

This research aims to understand the barriers that are present within individuals and within the healthcare system that may lead to a failure to take antiretroviral medications as prescribed. It will help clinicians and policy makers understand the association of antiretroviral adherence with the cost of care. If poor adherence to therapy is associated with increased costs of care, clinicians, researchers, and policy makers may be more willing to devote resources to the development of effective adherence interventions. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01AI067063-03
Application #
7173464
Study Section
Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
Program Officer
Livnat, Daniella
Project Start
2005-09-17
Project End
2010-07-31
Budget Start
2006-08-01
Budget End
2007-07-31
Support Year
3
Fiscal Year
2006
Total Cost
$131,308
Indirect Cost
Name
Denver Health and Hospital Authority
Department
Type
DUNS #
093564180
City
Denver
State
CO
Country
United States
Zip Code
80204
Rowan, Sarah E; Burman, William J; Johnson, Steven C et al. (2014) Engagement-in-care during the first 5 years after HIV diagnosis: data from a cohort of newly HIV-diagnosed individuals in a large US city. AIDS Patient Care STDS 28:475-82
Gardner, Edward M; Daniloff, Elaine; Thrun, Mark W et al. (2013) Initial linkage and subsequent retention in HIV care for a newly diagnosed HIV-infected cohort in Denver, Colorado. J Int Assoc Provid AIDS Care 12:384-90
Nachega, Jean B; Marconi, Vincent C; van Zyl, Gert U et al. (2011) HIV treatment adherence, drug resistance, virologic failure: evolving concepts. Infect Disord Drug Targets 11:167-74
Gardner, Edward M; McLees, Margaret P; Steiner, John F et al. (2011) The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 52:793-800
Gardner, Edward M; Hullsiek, Katherine H; Telzak, Edward E et al. (2010) Antiretroviral medication adherence and class- specific resistance in a large prospective clinical trial. AIDS 24:395-403
Parienti, Jean-Jacques; Bangsberg, David R; Verdon, Renaud et al. (2009) Better adherence with once-daily antiretroviral regimens: a meta-analysis. Clin Infect Dis 48:484-8
Gardner, Edward M; Burman, William J; Steiner, John F et al. (2009) Antiretroviral medication adherence and the development of class-specific antiretroviral resistance. AIDS 23:1035-46
Gardner, Edward M; Maravi, Moises E; Rietmeijer, Cornelis et al. (2008) The association of adherence to antiretroviral therapy with healthcare utilization and costs for medical care. Appl Health Econ Health Policy 6:145-55
Gardner, Edward M; Sharma, Shweta; Peng, Grace et al. (2008) Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance. AIDS 22:75-82
Gardner, Edward M; Burman, William J; Maravi, Moises E et al. (2006) Durability of adherence to antiretroviral therapy on initial and subsequent regimens. AIDS Patient Care STDS 20:628-36