. The applicant states that people over 50 years of age represent 11% of the population with AIDS and that their prevalence will increase as effective antiviral therapies improve survival. However, according to her, outcomes among older people with HIV are poor and the gap in survival between older and younger people has grown as treatment has become more effective. The applicant states that the conditions which mediate age-associated poorer survival are unknown. Also, that gerontological research suggests that poorer outcomes are often not due to age per se, but to differences in biological, medical, personal, and social risks and resources which mediate poorer outcomes. Further, that mediators in HIV may include co-morbid disease, medical care, and social and personal risks and resources, some of which may be mutable. The applicant's long-term objective is to establish a research career for herself, targeted at improving outcomes for middle-aged and older people with HIV. Her immediate goal is to use insights offered by social gerontology to better understand the older people with HIV. Her immediate goal is to use the insights from social gerontology to better understand the mediators of age-associated survival and quality of life in HIV infection. The proposed study plan includes mentoring by Dr. Eva Kahana, one-on-one tutorials with a group of primary supporting mentors, coursework, and participation in seminars and colloquia on topics in social gerontology, quality of life, and research methods. The research phase of this application is conditioned by the prevalence of middle-aged and older people with HIV in Veterans Affairs Medical Centers (VAMCs). A conceptual model for mediators of age-associated patient outcomes has been developed.
The specific aims of the research are to identify: 1) biological and medical mediators of age-associated HIV outcomes; 2) personal and social mediators of age-associated HIV outcomes; and 3) mutable mediators of age-associated outcomes in people with HIV. The research will involve a cohort of 2,744 outpatients of VAMCs at Cleveland, Houston, and Manhattan, using a prospective design. Following instrument adaptation and piloting, enrollment will proceed for 30 months. Twelve-month followup for quality of life and 1- to 3.5-year followup for survival will be obtained. Data sources include computerized data, patient and physician surveys, and chart review. Quantitative methods will be supplemented with qualitative research. Related to institutional resources in social gerontology, outcomes research, and infectious disease as well as on ties with an AIDS Clinical Trials Group, the proposed research and study plan form the basis for sustained career development. By virtue of the requested support, the applicant believes she will gain the experience and insight needed to conduct multidisciplinary interventional studies to improve outcomes for middle-aged and older people with HIV.
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