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. ? ?
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