IMPROVING HEALTH CARE UTILIZATION IN HIV+ DRUG USERS

格博博士是罗伯特·伍德·约翰逊临床学者，并将成为约翰·霍普金斯大学的传染病研究员(2000-01)。在过去的两年里，她一直在为艾滋病毒携带者进行流行病学和卫生服务结果研究，其中许多人是吸毒者。通过这个奖项，Gebo博士希望作为约翰·霍普金斯大学传染病系的一名教员，对药物滥用和艾滋病毒感染之间的相互作用进行卫生服务研究。她将得到艾滋病毒流行病学和卫生服务研究专家理查德·摩尔博士和尼尔·鲍尔博士的指导，以及药物滥用和吸毒者艾滋病毒卫生服务利用方面的知名研究人员玛丽·麦克考尔和芭芭拉·特纳博士的合作。为了补充她的研究，Gebo博士将在公共卫生学院完成药物滥用、伦理学以及高级生物统计学和卫生服务研究方法的课程。蛋白水解酶抑制剂被证明可以降低HIV患者的发病率和死亡率。在试点数据中，Gebo博士发现，1995至1997年间，我们的艾滋病毒患者的住院率显著下降；然而，在有非法药物使用史的患者中，这一趋势明显减弱。非法药物使用与艾滋病毒患者的住院密切相关，即使在对抗逆转录病毒使用进行调整后也是如此。为了探索这一点，格博博士将对约翰·霍普金斯大学艾滋病毒诊所的患者进行一项队列研究，她将在那里通过时间序列分析检查1998至2001年间的住院和门诊服务利用率。她还将对2001年在约翰·霍普金斯艾滋病毒诊所登记的患者进行一项横断面研究，以检查预防性护理利用的充分性。在评估使用模式后，她将对药物滥用患者进行强化病例管理干预，以增加药物滥用治疗，减少药物使用。最后，她将对干预进行成本效益分析。该奖项的目标是找出艾滋病毒患者过度和未充分利用医疗保健的领域，并增加药物滥用治疗转介的完成率，减少艾滋病毒吸毒者的总体药物使用。利用现有数据来源的研究，以及干预计划和初级数据收集、资深科学家的出色指导、可用的课程以及约翰·霍普金斯大学的支持性环境相结合，将为Gebo博士提供她发展为艾滋病毒流行病学和卫生服务研究的独立临床研究员所需的技能。

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.