The HIV Costs and Services Utilization Study (HCSUS) data show that thre are disparities between minorities and whites in the proportion taking highly active anti-retroviral therapy (HAART), the proportion adhering to anti-retroviral therapy (ARV), and in survival rates. HCSUS also shows high rates of unmet need for social and medical services for minorities. Lower levels of these unmet service needs associated with case- management predict improved rates of use of ARV therapy. This proposal builds on these findings in HCSUS and the findings of studies in Log Angeles (such as the Adherence and Efficacy of Protease inhibitor Therapy [ADEPT] study) on barriers to adherence in order to identify mutable factors explaining these differences. These mutable factors will be the combined targets of a new randomized intervention clinical trial designed to help minority patients with HIV infection to overcome barriers to care by enhancing case-management and adhere to treatment regimens. We will use theory-based behavior change methods to facilitate adherence of HIV infected minority patients to their prescribed regimens.
The specific aims of this proposal are: 1) to analyze existing databases of HIV-infected populations (including HCSUS and ADEPT) and identify key mutable predictors of adherence and outcomes to guide development of a potent intervention targeting the disparities in adherence and outcomes between minorities and Whites with HIV infection; 2) to implement this intervention as a randomize trial of case management and adherence counseling in minorities with HIV infection to: a) improve their adherence to medical visits to overcome barriers; b) increase adherence to prescribed regimens; and ultimately, c) suppress HIV viral replication and improve other HIV-related health outcomes; 3) to assess the cost-effectiveness of the intervention. The goal is to assist minority persons with HIV infection to meet their social needs through case- management, and as result keep medical appointments (service adherence) and adhere to treatment (medical adherence). After refining the procedures and the instruments based on initial testing, we will implement a full randomized intervention and evaluate its initial and subsequent impact in the treatment arm compared to controls, for the main outcomes: service adherence, medication, adherence, and viral load suppression. We will assess basic sociodemographics, attitudes, beliefs, and intentions toward adhering, barriers to appointment keeping, utilization (including outpatient and ER visits, and hospitalizations), costs, prescription filing, competing needs, unmet needs for supportive services, case-management, sources of care, barriers (including trust, literacy, and discrimination), drug and alcohol use, symptoms, physical and mental health status, utilities (EuroQOL), mental disorders and social support. We will assess cost-effectiveness by computing the marginal costs associated with suppressing viral load for intervention vs. control groups.
| Calderón, José Luis; Bazargan, Mohsen; Sangasubana, Nisaratana et al. (2010) A comparison of two educational methods on immigrant Latinas breast cancer knowledge and screening behaviors. J Health Care Poor Underserved 21:76-90 |
| Tobias, Carol; Cunningham, William E; Cunningham, Chinazo O et al. (2007) Making the connection: the importance of engagement and retention in HIV medical care. AIDS Patient Care STDS 21 Suppl 1:S3-8 |
| Rumptz, Maureen H; Tobias, Carol; Rajabiun, Serena et al. (2007) Factors associated with engaging socially marginalized HIV-positive persons in primary care. AIDS Patient Care STDS 21 Suppl 1:S30-9 |
| Calderon, Jose L; Baker, Richard S; Fabrega, Horacio et al. (2006) An ethno-medical perspective on research participation: a qualitative pilot study. MedGenMed 8:23 |
| Morales, Leo S; Staiger, Douglas; Horbar, Jeffrey D et al. (2005) Mortality among very low-birthweight infants in hospitals serving minority populations. Am J Public Health 95:2206-12 |
| Wong, Mitchell D; Tagawa, Tomoko; Hsieh, Hsin-Ju et al. (2005) Differences in cause-specific mortality between Latino and white adults. Med Care 43:1058-62 |
| Calderon, Jose L; Shaheen, Magda; Pan, Deyu et al. (2005) Multi-cultural surveillance for ectopic pregnancy: California 1991-2000. Ethn Dis 15:S5-20-4 |
| Rogowski, Jeannette A; Staiger, Douglas O; Horbar, Jeffrey D (2004) Variations in the quality of care for very-low-birthweight infants: implications for policy. Health Aff (Millwood) 23:88-97 |
| Calderon, Jose Luis; Zadshir, Ashraf; Norris, Keith (2004) A survey of kidney disease and risk-factor information on the World Wide Web. MedGenMed 6:3 |
| Calderon, Jose Luis; Zadshir, Ashraf; Norris, Keith (2004) Structure and content of chronic kidney disease information on the World Wide Web: barriers to public understanding of a pandemic. Nephrol News Issues 18:76, 78-9, 81-4 |
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