Highly active antiretroviral therapy (HAART) has reduced mortality in patients with HIV. Crude CDC data demonstrate that, though they had the same mortality in the pre-HAART era, mortality in 2000 was >15% higher for Hispanics with AIDS and >50% higher for African Americans with AIDS, compared to whites. The effectiveness of HAART has not been assessed in a nationally distributed population with HIV, and the factors contributing the mortality discrepancy are not well known. The goals of this proposal are to assess the magnitude of the HAART-era mortality discrepancy by race/ethnicity, and identify potentially modifiable factors responsible for that discrepancy. The research is based on a model of care that outlines crucial Steps of HIV Care, which in turn determine the overall effectiveness of HAART in clinical practice. These steps are: a) access outpatient care, b) utilize care services, and c) adhere to care. Past studies and preliminary data indicate that minorities may have difficulty with all 3 steps, but the relative influence that patient and process of care factors have on these Steps and the effect that the Steps have on survival are unknown.
The specific aims for this proposal are:
Specific Aim 1 : To determine if the mortality rates of patients with HIV in routine clinical practice differed by race/ethnicity in the pre-HAART and HAART eras;
Specific Aim 2 : To evaluate the relationship between the Steps of HIV Care, patient factors, and mortality;
Specific Aim 3 : To develop an instrument to assess newly diagnosed HIV-infected patients' attitudes and beliefs about HIV disease and care;
Specific Aim 4 : To evaluate the relationship between patients' attitudes and beliefs about HIV disease and care and patients' success in following the Steps of HIV Care. The first 2 Aims will be accomplished with retrospective cohort studies using a unique, national, Veteran's Health Administration HIV registry; the 3rd Aim with focus group and pilot studies of persons with HIV; and the last Aim with a prospective cohort study of patients newly diagnosed with HIV during hospitalization. This research will expand upon the principle investigator's current skills and past work by taking advantage of an outstanding research and mentoring environment, allowing him to acquire new and refine existing skills in the design and performance of patient-oriented clinical research, so that he will be an independent researcher improving the health of people with HIV. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23MH067505-02
Application #
6685265
Study Section
Special Emphasis Panel (ZRG1-AARR-8 (01))
Program Officer
Gordon, Christopher M
Project Start
2002-12-01
Project End
2007-11-30
Budget Start
2003-12-01
Budget End
2004-11-30
Support Year
2
Fiscal Year
2004
Total Cost
$179,796
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
Giordano, Thomas P; Bartsch, Glenn; Zhang, Yafeng et al. (2010) Disparities in outcomes for African American and Latino subjects in the Flexible Initial Retrovirus Suppressive Therapies (FIRST) trial. AIDS Patient Care STDS 24:287-95
Chiao, Elizabeth Y; Engels, Eric A; Kramer, Jennifer R et al. (2009) Risk of immune thrombocytopenic purpura and autoimmune hemolytic anemia among 120 908 US veterans with hepatitis C virus infection. Arch Intern Med 169:357-63
Giordano, Thomas P; Hartman, Christine; Gifford, Allen L et al. (2009) Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials 10:299-305
Clark, April; Mayben, Jennifer K; Hartman, Christine et al. (2008) Conspiracy beliefs about HIV infection are common but not associated with delayed diagnosis or adherence to care. AIDS Patient Care STDS 22:753-9
Chiao, Elizabeth Y; Giordano, Thomas P; Richardson, Peter et al. (2008) Human immunodeficiency virus-associated squamous cell cancer of the anus: epidemiology and outcomes in the highly active antiretroviral therapy era. J Clin Oncol 26:474-9
Kramer, Jennifer R; Giordano, Thomas P; El-Serag, Hashem B (2007) Effect of human immunodeficiency virus and antiretrovirals on outcomes of hepatitis C: a systematic review from an epidemiologic perspective. Clin Gastroenterol Hepatol 5:1321-1328.e7
Mayben, J K; Giordano, T P (2007) Internet use among low-income persons recently diagnosed with HIV infection. AIDS Care 19:1182-7
Giordano, Thomas P; Henderson, Louise; Landgren, Ola et al. (2007) Risk of non-Hodgkin lymphoma and lymphoproliferative precursor diseases in US veterans with hepatitis C virus. JAMA 297:2010-7
Mayben, Jennifer K; Kramer, Jennifer R; Kallen, Michael A et al. (2007) Predictors of delayed HIV diagnosis in a recently diagnosed cohort. AIDS Patient Care STDS 21:195-204
Giordano, Thomas P; Gifford, Allen L; White Jr, A Clinton et al. (2007) Retention in care: a challenge to survival with HIV infection. Clin Infect Dis 44:1493-9

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