Comparative Effectiveness of Alcohol and Drug Treatment in HIV-Infected Veterans

酒精和药物治疗对感染艾滋病毒的退伍军人的比较效果

• 批准号: 9059547
• 负责人: KEVIN L KRAEMER
• 金额: $ 54.93万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9059547
• 关键词: Affect; Affordable Care Act; African American; Aging; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Area; Behavior Therapy; Caring; Code; Cohort Studies; Data; Disease Progression; Equation; Experimental Designs; HIV; HIV Infections; Health; Health Care Reform; Health Services Accessibility; Homelessness; ICD-9; Individual; Insurance; Insurance Coverage; Laboratories; Link; Logistic Regressions; Medicare/Medicaid; Methods; Military Personnel; Minority; Outcome; Participant; Pathology; Patient Self-Report; Patients; Pharmacotherapy; Pharmacy facility; Population; Provider; Race; Regression Analysis; Rural; Sampling; Substance Use Disorder; Surveys; Time; Update; Veterans; Work; alcohol abuse therapy; alcohol intervention; base; cohort; comparative effectiveness; compare effectiveness; cost; disease transmission; effectiveness research; health service use; improved; men who have sex with men; prospective; residence; treatment strategy; virtual

DESCRIPTION (provided by applicant): Although alcohol and substance use disorders (ASUDs) are common in HIV-infected patients, little is known about the efficacy and comparative effectiveness of ASUD treatments in HIV-infected populations. Further, because few individuals with ASUD receive high quality ASUD treatment of any type, understanding the factors associated with initiating, engaging, and remaining in ASUD treatment is at least as important as the specific type of treatment. Understanding issues of treatment initiation, engagement, and retention is critical to advancing comparative effectiveness research in ASUD, particularly as provisions of the Affordable Care Act (ACA) are implemented. We will use the Veterans Aging Cohort Study (VACS) to study the comparative effectiveness and delivery of ASUD treatment in HIV-infected Veterans. VACS is a large multisite, national study with 2 main components: 1) a "Virtual" Cohort of 44,180 HIV-infected Veterans and 88.360 uninfected comparators on which we have access to administrative, pharmacy, laboratory, pathology, health service utilization, and linked Medicaid/Medicare data; and 2) VACS 8, a prospective cohort of 3631 HIV-infected and 3693 matched HIV-uninfected Veterans that adds annual self-report survey information to data available in the Virtual Cohort. Our Specific Aims are to: 1) Compare the effectiveness of initiation, engagement, and retention in different types of ASUD treatment on quality of HIV care, virologic suppression, and costs in HIV-infected Veterans with ASUD; 2) Identify predictors of initiation, engagement, and retention in ASUD treatment in HIV- infected Veterans; and 3) Assess effects of ACA insurance expansion on initiation, engagement, and retention in ASUD treatment for HIV-infected Veterans. Aims 1 and 2 will use the VACS Virtual Cohort and Aim 3 will use the VACS 8 prospective cohort. For Aim 1, we will use a quasi-experimental, propensity-score adjusted, difference-in-differences analysis of outcomes before and after new ASUD treatment episodes in VACS Virtual Cohort participants. For Aim 2, we will conduct time-updated, generalized estimating equations logistic regression analyses to identify independent predisposing, enabling, and need predictors of initiation, engagement, and retention in ASUD treatment among HIV-infected VACS Virtual Cohort participants. For Aim 3, we will use a mixed-methods approach to prospectively assess HIV-infected VACS 8 participants with ASUD over several years as the ACA insurance expansion occurs. Achieving these aims will provide "real world" estimates of which ASUD strategies are associated with the best outcomes in a national sample of vulnerable HIV-infected patients and identify factors associated with increased engagement and retention in treatment.

描述（由申请人提供）：尽管酒精和药物使用障碍（ASUD）在HIV感染的患者中很常见，但对ASUD治疗在HIV感染人群中的疗效和比较有效性知之甚少。此外，由于很少有ASUD的人接受任何类型的高质量ASUD治疗，因此了解与启动，参与和保持ASUD治疗相关的因素至少与特定类型的治疗一样重要。了解治疗开始，参与和保留问题对于推进ASUD的比较有效性研究至关重要，特别是由于实施了《平价医疗法案》（ACA）的规定。我们将使用退伍军人老化队列研究（VAC）来研究HIV感染的退伍军人中ASUD治疗的比较有效性和递送。 VACS是一项大型多站点研究，具有2个主要组成部分：1）44,180名HIV感染的退伍军人和88.360个未感染的比较器的“虚拟”队列，我们​​可以在其中访问行政，药房，实验室，病理学，卫生服务，卫生服务，以及链接的医疗保险/医疗保险数据； 2）VACS 8，由3631 HIV感染的预期队列和3693匹配的HIV未感染的退伍军人，将年度自我报告调查信息添加到虚拟队列中可用的数据中。我们的具体目的是：1）比较在不同类型的ASUD治疗中，在艾滋病毒护理质量，病毒学抑制和与ASUD的艾滋病毒感染的退伍军人中相比，在不同类型的ASUD治疗中比较启动，参与和保留的有效性； 2）确定在艾滋病毒感染的退伍军人中，在ASUD治疗中的开始，参与和保留的预测因素； 3）评估ACA保险扩展对HIV感染退伍军人的ASUD治疗的启动，参与和保留的影响。 AIMS 1和2将使用VACS虚拟队列，AIM 3将使用VACS 8潜在队列。对于AIM 1，我们将使用准实验性，倾向得分调整后的，差异分析的分析，对VACS虚拟队列参与者的新ASUD治疗发作之前和之后的结果分析。对于AIM 2，我们将进行序列的，广义的估计方程逻辑回归分析，以识别独立的诱发，启用和需求预测的启动，参与度和保留在HIV感染的VACS VACS虚拟队列参与者中的ASUD治疗中。对于AIM 3，我们将使用一种混合方法方法来预期评估受ACA保险扩展的数年以来，有几年的ASUD参与者。实现这些目标将提供“现实世界”的估计，其中ASUD策略与全国性脆弱的艾滋病毒感染患者样本中的最佳结果相关，并确定与增加参与和保留治疗有关的因素。