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: 8831574
• 负责人: KEVIN L KRAEMER
• 金额: $ 50.26万
• 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/8831574
• 关键词: Affect; 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; Pharmaceutical Preparations; Pharmacotherapy; Pharmacy facility; Population; Provider; Race; Regression Analysis; Rural; Sampling; Substance Use Disorder; Surveys; Time; Update; Veterans; Work; alcohol intervention; base; cohort; comparative effectiveness; compare effectiveness; cost; disease transmission; effectiveness research; health care service utilization; 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）：尽管酒精和物质使用障碍（ASUD）在hiv感染患者中很常见，但对于ASUD治疗在hiv感染人群中的疗效和比较效果知之甚少。此外，由于很少有ASUD患者接受任何类型的高质量ASUD治疗，因此了解与ASUD治疗开始、参与和保持相关的因素至少与特定类型的治疗同样重要。了解治疗开始、参与和保留的问题对于推进ASUD的比较有效性研究至关重要，特别是在实施平价医疗法案（ACA）的规定时。我们将使用退伍军人老龄化队列研究（VACS）来研究ASUD治疗在hiv感染退伍军人中的比较有效性和交付。VACS是一项大型、多地点的全国性研究，有两个主要组成部分：1)一个由44180名感染艾滋病毒的退伍军人和88.360名未感染的比较者组成的“虚拟”队列，我们可以获得行政、药房、实验室、病理、卫生服务利用和相关的医疗补助/医疗保险数据；2) VACS 8，一个包含3631名感染hiv和3693名匹配的未感染hiv的退伍军人的前瞻性队列，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。我们的具体目标是：1)比较不同类型ASUD治疗的开始、参与和保留对HIV感染的ASUD退伍军人的HIV护理质量、病毒学抑制和成本的影响；2)确定HIV感染退伍军人ASUD治疗开始、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ASUD治疗的开始、参与和保留的影响。目标1和2将使用VACS虚拟队列，目标3将使用VACS 8前瞻性队列。在目的1中，我们将对VACS虚拟队列参与者新的ASUD治疗发作前后的结果进行准实验、倾向评分调整、差异中差异分析。对于目标2，我们将进行时间更新的广义估计方程逻辑回归分析，以确定hiv感染的VACS虚拟队列参与者中ASUD治疗开始、参与和保留的独立易感因素、启用因素和需求预测因素。在第3项研究中，我们将采用混合方法，在ACA保险扩大后的几年内对患有ASUD的hiv感染VACS 8参与者进行前瞻性评估。实现这些目标将提供“真实世界”的估计，即在全国易感艾滋病毒感染患者样本中，哪些ASUD策略与最佳结果相关，并确定与增加参与和坚持治疗有关的因素。