Dr. William C. Holmes, a National Research Service Award Fellow in the Division of General Internal Medicine at the University of Pennsylvania Medical Center, is applying for a Mentored Clinical Scientist Development Award in order to develop and enhance the skills necessary for an academic career as an independent investigator. The candidate's research interest focus on assessing health status outcomes of people with HIV/AIDS, with a particular emphasis on the development of health status measures. This application requests support that will allow Dr. Holmes to complete an independent investigator development program that includes coursework further enhancing knowledge of health status measurement and leading to a Ph.D. in Epidemiology, mentorship and consultation with experts in health status measurement, and completion of a research protocol that will generate important advances in the field of HIV/AIDS-targeted health status measurement. HIV infection remains a growing cause of death and disability in this country and the world. Affected individuals are faced with quality of life concerns that are not typical for their age group nor their generally well health status. As a result, existing generic quality of life measures (whether modified for use in the HIV/AIDS population or not) do not adequately assess the broad and complex quality of life concerns of seropositive individuals. Quality-of-life-defined health states of HIV seropositives individuals remain undefined as well, as do the preference for such health states. This application proposes a five-year, three-phase research plan, building on preliminary studies the produced an early version of an HIV/AIDS-targeted quality of life measure. The first study proposed is longitudinal in design, the aim of which is to evaluate test-retest reliability and responsiveness, in HIV seropositive individuals, of both a well-known, generic quality of life measure (e.g., SF-36) and the preliminary instrument. The second study is cross-sectional in design, and is intended to assess psychometric properties of a """"""""core-plus- module"""""""" instrument, one that combines dimensions from the generic measure, evaluated in study one, with those from the preliminary, HIV/AIDS-targeted instrument. Consensus opinion offered by the - Outcomes Committee of the AIDS Clinical Trial Group will determine the make-up of the core-plus-module instrument. Psychmetric properties of the instruments, determined in preliminary studies and study one, will guide decisions. This instrument will allow comparison of the HIV population with other diseased and well populations (generic core), while providing appraisal of HIV/AIDS-targeted concerns (HIV/AIDS-targeted module). The third study will use the core-plus-module measure to define HIV/AIDS- specific health states, again determined by consensus opinion of the Outcomes Committee, for which preferences will be measured using comparative methods of visual analogue scale, standard gamble, conjoint analysis, and difference measurement.
