IMPROVING HEALTH CARE UTILIZATION IN HIV+ DRUG USERS

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Dr. Gebo is a Robert Wood Johnson Clinical Scholar and will be an infectious disease fellow at the Johns Hopkins University (2000-01). She has spent the past two years conducting epidemiologic and health services outcomes research for individuals with HIV, many of whom are drug users. Through this award, Dr. Gebo would like to conduct health services research on the interaction of drug abuse and HIV infection, as a faculty member in Infectious Diseases at Johns Hopkins. She will have the mentorship of Drs. Richard Moore and Neil Powe, experts in HIV epidemiologic and health services research, as well as the collaboration of Drs. Mary McCaul and Barbara Turner, established researchers in drug abuse and HIV health services utilization of drug users. To complement her research, Dr. Gebo will complete courses in the School of Public Health in substance abuse, ethics, and advanced biostatistics and health services research methods. Protease inhibitors were shown to decrease morbidity and mortality in HIV+ patients. In pilot data, Dr. Gebo found that hospitalization rates in our HIV+ patients decreased significantly between 1995 and 1997; however, this trend was markedly attenuated in patients with a history of illicit drug use. Illicit drug use is strongly associated with hospitalization among HIV+ patients, even after adjustment for antiretroviral use. To explore this, Dr. Gebo will perform a cohort study on patients followed in the Johns Hopkins HIV clinic where she will examine hospitalization and outpatient care utilization rates, in a time-series analysis, between 1998 and 2001. She will also conduct a cross-sectional study of patients enrolled in the Johns Hopkins HIV Clinic in 2001 to examine the adequacy of preventive care utilization. After assessing utilization patterns, she will conduct an intervention of intensive case management in substance abusing patients to increase substance abuse treatment and decrease substance use. Finally, she will conduct a cost-effectiveness analysis of the intervention. The goals of the award are to identify areas of over and under utilization of health care by HIV+ patients, and to increase completion of substance abuse treatment referrals and decrease overall substance use in HIV+ drug users. The combination of research utilizing existing data sources, as well as intervention planning and primary data collection, the excellent mentorship of senior scientists, the coursework available, and the supportive environment of the Johns Hopkins University will provide Dr. Gebo the skills she needs to develop into an independent clinician researcher in HIV epidemiologic and health services research.