Epidemiologic Evaluation of State AIDS Drug Assistance Program Features in the US

美国各州艾滋病药物援助计划特点的流行病学评估

• 批准号: 8012038
• 负责人: David B. Hanna
• 金额: $ 4.14万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8012038
• 关键词: Acquired Immunodeficiency Syndrome; Affect; American; Anti-HIV Agents; Antiviral Therapy; Calendar; Caring; Client; Clinical; Clinical effectiveness; Collaborations; Comorbidity; Cost Control; Data; Drug abuse; Drug user; Eligibility Determination; Epidemiology; Evaluation; Formularies; Funding; Guidelines; HIV; HIV Infections; Health; Health Policy; Hepatitis C; Heterogeneity; Highly Active Antiretroviral Therapy; Illicit Drugs; Individual; Life; Low income; Measures; Medical; Methods; Opiate Addiction; Opportunistic Infections; Outcome; Persons; Pharmaceutical Preparations; Policies; Prophylactic treatment; Public Health; Quality of Care; Recording of previous events; Research; Research Design; Services; Subgroup; Time; Underinsured; Uninsured; United States; Variant; addiction; base; cohort; epidemiologic data; mortality; multilevel analysis; programs; public health relevance; residence; response; safety net

DESCRIPTION (provided by applicant): AIDS Drug Assistance Programs (ADAPs) are federally-funded, state-administered programs that act as the drug "safety net" for primarily low-income, underinsured, or uninsured HIV- infected individuals. ADAPs may differ from state to state based on financial eligibility criteria, cost-containment measures, and inclusiveness of drug formularies with respect to antiviral therapies, opportunistic infection prophylaxis, and addiction treatment. These variations in state ADAP policies may result in similar HIV-infected persons having different health outcomes due to their state of residence. The objective of this research is to determine the association between specific structural features of state ADAPs on individual-level clinical outcomes among HIV-infected persons in the United States between 1998 and 2008. This will be conducted based on data from persons living in 25 states who are part of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Aim 1 of this research will determine the level of heterogeneity in health outcomes by state of residence with respect to HAART initiation (among those who are eligible for treatment initiation based on clinical guidelines) and one-year HIV virologic response and one- and three-year mortality (among those initiating HAART), controlling for individual-level factors, state-level factors, and calendar time. Aim 2 will examine the association between selected state ADAP structural features on HAART initiation among clinically eligible persons using multilevel modeling strategies, controlling for potential confounders. Finally, Aim 3 will determine the association between selected state ADAP structural features and one-year HIV virologic response and one- and three-year mortality among persons initiating HAART using instrumental variable methods. Subgroup analyses will be performed among current and former drug users, many of whom are ADAP clients and who may especially benefit from ADAP services given their lower access to quality care and greater medical needs as a consequence of co-morbidities such as hepatitis C virus infection and opioid addiction. PUBLIC HEALTH RELEVANCE: Epidemiologic data are needed to evaluate the effects of state policies on clinical outcomes in persons with HIV infection. Because individual states decide on many policies that affect the health of persons with HIV infection, comparisons of the clinical effectiveness of various features of state AIDS Drug Assistance Programs (ADAPs) may help to influence changes to policies by identifying those that minimize negative health consequences like mortality. Such information is especially relevant to public health policy since ADAP clients represent over one- third of all persons with HIV infection receiving care in the United States, many of whom have a history of illicit drug abuse.

描述（由申请人提供）： 艾滋病药物援助计划（ADAP）是由联邦政府资助的国家管理计划，这些计划是主要是低收入，保险或未保险的艾滋病毒感染者的药物“安全网”。根据财务资格标准，成本控制措施以及药物配方在抗病毒疗法，机会性感染预防和成瘾治疗方面，ADAP可能因国家到州而异。这些状态ADAP政策的这些变化可能导致因其居住状况而具有不同健康结果的类似的HIV感染者。这项研究的目的是确定1998年至2008年之间，美国艾滋病毒感染者对艾滋病毒感染者之间个人水平临床结果的特定结构特征之间的关联。这将根据居住在北美艾滋病研究和设计方面的北美艾滋病队列合作的25个州的数据（NA-accord）的数据进行。这项研究的目标1将确定居住状态在HAART启动方面的健康结果中的异质性水平（在那些有资格根据临床指南获得治疗开始的人）和一年的HIV病毒反应和一年和三年的死亡率（在HAART中）（在HAART中），控制个人级别的因素，状态级别的因素，即层次的因素，以及级别的因素和日历时间和日历。 AIM 2将使用多层次建模策略来检查选定状态ADAP结构特征在临床符合条件的人之间的HAART启动之间的关联，从而控制潜在的混杂因素。最后，AIM 3将确定所选状态ADAP结构特征与使用仪器可变方法启动HAART的人之间一年的HIV病毒反应和一年和三年死亡的关联。亚组分析将在当前和前任吸毒者中进行，其中许多是ADAP客户，并且由于合并症（例如乙型肝炎病毒感染和阿片类药物成瘾）而获得优质护理和更大的医疗需求，他们可能会特别受益于ADAP服务。 公共卫生相关性： 需要流行病学数据来评估国家政策对HIV感染患者临床结果的影响。由于各个国家决定影响艾滋病毒感染患者健康的许多政策，因此比较国家艾滋病毒品援助计划（ADAPS）的各种特征的临床效力可能会通过识别那些减少死亡率（如死亡率）的负面健康后果来帮助影响政策的变化。此类信息尤其与公共卫生政策有关，因为ADAP客户代表了在美国接受护理的所有艾滋病毒感染患者的三分之一，其中许多人都有非法药物滥用的病史。