Secondary Analysis of Existing Alcohol & HIV/AIDS Data

描述（由申请人提供）：拟议研究的目的是检查饮酒对(1)与感染艾滋病毒相关的个人预防和风险行为的影响，(2)艾滋病毒阳性个体服用艾滋病毒药物的可能性和依从性，(3)健康状况，以及(4)卫生保健的利用和成本，包括获得卫生保健和保险的障碍。这些关系将使用四个数据库进行分析：艾滋病毒成本和服务利用研究（HCSUS）、东南地区应对艾滋病毒/艾滋病（CHASE）、具有相关死亡率数据的全国健康访谈调查（NHIS）和医疗支出小组调查（MEPS）。酒精损害个人理性思考的能力，可能增加诸如无保护的性行为或静脉注射毒品等危险行为，并可能降低诸如艾滋病毒检测等预防措施。这些关系将使用NHIS、HCSUS和CHASE进行分析。酒精会改变HIV药物降低病毒载量的效果。医生可能会避免给酗酒者开抗艾滋病毒药物，因为担心由于不充分遵守处方药物治疗方案而使艾滋病毒产生耐药性。这些关系将使用HCSUS和CHASE进行分析。酒精会削弱人的免疫系统和应对能力，尤其是艾滋病毒感染者。将使用HCSUS和CHASE研究酒精对自我报告的健康和功能、合并感染以及CD4计数和病毒载量等临床标志物的影响。大量饮酒降低了个人就业和拥有私人保险的可能性，并增加了接受医疗补助或没有保险的可能性。因此，酒精性艾滋病毒感染者在获得适当医疗服务方面更有可能面临问题。将使用HCSUS、CHASE、MEPS和NHIS研究酒精、保险覆盖、医疗保健利用和成本之间的关系。由于使用了来自多个来源的纵向数据，拟议的分析将大大提高我们对因果途径的认识；提供与艾滋病毒阳性个体大量饮酒相关的费用估计数；允许对美国人口和艾滋病毒阳性成年人进行全国估计；提供对南方腹地的关联的当前估计；我们的数据涵盖了自艾滋病毒开始流行以来的大部分时间，因此可以评估这种关系随着时间的变化。

DESCRIPTION (provided by applicant): The purpose of the proposed study is to examine the effects of alcohol consumption on (1) individuals' preventive and risk behaviors associated with contracting HIV, (2) the probability of HIV positive individuals being prescribed HIV medications and adherence to such medication, (3) health status, and (4) health care utilization and costs, including barriers to accessing health care and insurance coverage. These relationships will be analyzed using four databases: the HIV Cost and Services Utilization Study (HCSUS), Coping with HIV/AIDS in the Southeast (CHASE), the National Health Interview Surveys (NHIS) with linked mortality data, and the Medical Expenditure Panel Survey (MEPS). Alcohol impairs individuals' ability to think rationally, may increase risk behaviors such as unprotected sex or IV drug use, and may decrease prevention efforts such as testing for HIV. These relationships will be analyzed using NHIS, HCSUS, and CHASE. Alcohol alters the effectiveness of HIV medications in reducing the viral load. Physicians may avoid prescribing HIV medications to alcoholics for fear of the HIV virus developing drug resistance due to inadequate adherence to prescribed drug regimens. These relationships will be analyzed using HCSUS and CHASE. Alcohol weakens an individual's immune system and coping abilities, especially in HIV infected persons. The effect of alcohol on self-reported health and functioning, co-infections, and clinical markers such as CD4 count and viral load will be studied using HCSUS and CHASE. Heavy alcohol consumption reduces an individual's likelihood of being employed and having private insurance, and increases the likelihood of being on Medicaid or uninsured. Thus, alcoholic HIV infected persons are more likely to face problems in accessing adequate medical care. The relationship between alcohol, insurance coverage, health care utilization and costs will be studied using HCSUS, CHASE, MEPS and NHIS. The proposed analyses will greatly improve our knowledge of causal pathways due to the use of longitudinal data from multiple sources; provide estimates of cost associated with heavy alcohol consumption in HIV positive individuals; allow for national estimates for the U.S. population and for HIV positive adults; provide current estimates of the associations for the Deep South; and allow for an evaluation of changes in the relationships over time as our data span much of the time period since the beginning of the HIV epidemic.