IMPROVING HEALTH CARE UTILIZATION IN HIV+ DRUG USERS

Gebo博士是Robert Wood Johnson临床学者，并将在约翰霍普金斯大学（2000-01）担任传染病研究员。过去两年来，她一直在为艾滋病毒感染者（其中许多人是吸毒者）进行流行病学和卫生服务结果研究。通过这个奖项，Gebo博士将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。她将得到博士的指导。Richard Moore和Neil Powe是艾滋病毒流行病学和卫生服务研究方面的专家。玛丽·麦考尔和芭芭拉·特纳，在药物滥用和艾滋病毒卫生服务吸毒者的利用方面建立了研究人员。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。蛋白酶抑制剂可降低HIV+患者的发病率和死亡率。在试点数据中，Gebo博士发现，1995年至1997年期间，我国艾滋病毒阳性患者的住院率显著下降；然而，这一趋势在有非法药物使用史的患者中明显减弱。非法药物使用与艾滋病毒阳性患者住院密切相关，即使在调整抗逆转录病毒使用后也是如此。为了探索这一点，Gebo博士将对约翰霍普金斯大学艾滋病诊所的患者进行一项队列研究，在1998年至2001年期间，她将对住院和门诊护理的使用率进行时间序列分析。她还将对2001年在约翰霍普金斯艾滋病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，她将对干预措施进行成本效益分析。该奖项的目标是确定艾滋病毒阳性患者对保健服务利用过度和不足的领域，增加药物滥用治疗转诊的完成情况，并减少艾滋病毒阳性吸毒者的总体药物使用情况。利用现有数据源的研究、干预计划和主要数据收集、资深科学家的优秀指导、现有的课程以及约翰霍普金斯大学的支持性环境，将为Gebo博士提供发展成为艾滋病毒流行病学和卫生服务研究方面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.