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: 8116059
• 负责人: David B. Hanna
• 金额: $ 4.18万
• 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/8116059
• 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 usage; Drug user; Eligibility Determination; Epidemiology; Evaluation; Formularies; Funding; Guidelines; HIV; HIV Infections; Health; Health Policy; Hepatitis C; Heterogeneity; Highly Active Antiretroviral Therapy; Individual; Injection of therapeutic agent; Life; Low income; Measures; Medical; Methods; Opiate Addiction; Opportunistic Infections; Outcome; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Prophylactic treatment; Public Health; Quality of Care; Recording of previous events; Research; Research Design; Services; Subgroup; Time; Underinsured; Uninsured; United States; Variant; Viral; Waiting Lists; addiction; base; cohort; epidemiologic data; mortality; multilevel analysis; programs; residence; response; safety net

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.

艾滋病药物援助计划 (ADAP) 是由联邦资助、州管理的计划，主要为低收入、保险不足或未投保的艾滋病毒感染者充当药物“安全网”。根据财务资格标准、成本控制措施以及药物处方集在抗病毒治疗、机会性感染预防和成瘾治疗方面的包容性，各州的 ADAP 可能有所不同。州 ADAP 政策的这些差异可能会导致类似的 HIV 感染者因其居住州而具有不同的健康结果。本研究的目的是确定 1998 年至 2008 年间美国各州 ADAP 的具体结构特征与 HIV 感染者个体水平临床结果之间的关联。这项研究将根据居住在 25 个州的人的数据进行他们是北美艾滋病队列研究与设计合作组织 (NA-ACCORD) 的一部分。本研究的目标 1 将确定不同居住州在 HAART 启动（根据临床指南有资格开始治疗的人群中）、一年 HIV 病毒学应答以及一年和三年的健康结果的异质性水平。年死亡率（在开始 HAART 的患者中），控制了个人因素、州因素和日历时间。目标 2 将使用多级建模策略，控制潜在的混杂因素，检查临床合格人群中选定的 ADAP 结构特征与 HAART 启动之间的关联。最后，目标 3 将使用工具变量方法确定选定的州 ADAP 结构特征与一年 HIV 病毒学应答以及开始 HAART 患者一年和三年死亡率之间的关联。亚组分析将在当前和以前的吸毒者中进行，其中许多人是 ADAP 客户，由于丙型肝炎病毒感染等共病，他们获得优质护理的机会较少，而医疗需求更大，因此他们可能特别受益于 ADAP 服务和阿片类药物成瘾。