Drugs, gender and healthcare use among HIV+ homeless

描述（由申请人提供）：这是一项研究性别，住房状况，药物使用，精神疾病和卫生服务利用之间的关系，以及它们对艾滋病毒感染者的健康状况的影响。本研究的具体目的如下：1）研究卫生服务利用（即，初级保健、药物治疗和精神卫生服务），并确定基线时以及28个月随访期内男女之间卫生服务利用模式的差异; 2）检查健康结果（身体和精神）在艾滋病毒感染的无家可归者和边缘居住的个人队列，并确定妇女在基线以及28个月随访期内与男子在健康结果方面的差异程度; 3）确定影响艾滋病毒感染的无家可归和边缘居住妇女在卫生服务利用和健康状况方面的差异的诱发因素、促成因素和需求因素。为实现这些具体目标，将开展以下活动：（1）再招募50名妇女加入先前存在的队列，以提高性别比较的统计能力;（2）在现有的REACH调查表中增加详细的毒品使用、健康、受害情况、生存需求和保健服务利用变量;（3）实施新的SCID诊断评估，以全面评估心理健康;（4）利用电子卫生服务数据库进行新的有效性研究;（5）对这些新的感兴趣领域进行具体分析。只有增加这些新的活动，最终产生新的分析类别，才有可能实现拟议的具体目标。对性别、药物使用、精神疾病、保健服务使用、获得食物等竞争性需求以及健康状况的影响和相互作用进行详细研究，将有助于更好地了解艾滋病毒感染者在边缘居住的个人中的持续死亡率，并为在各种环境中采取更有效的保健干预措施奠定基础。

DESCRIPTION (provided by applicant): This is a study of the relationships between gender, housing status, drug use, mental illness and health service utilization, as well as their impact on health status in a population of HIV-infected marginally housed individuals. The specific aims of the study are as follows: 1) To examine health service utilization (i.e., primary care, drug treatment, and mental health services) in a cohort of HIV-infected homeless and marginally individuals, and to determine differences in the patterns of health service utilization between women and men at baseline as well as over a 28 month follow-up period; 2) To examine health outcomes (physical and mental) in a cohort of HIV-infected homeless and marginally housed individuals, and to determine the extent to which women experience differences in health outcomes from men at baseline as well as over a 28 month follow-up period; and 3) To determine predisposing, enabling, and need factors influencing the differences that HIV-infected homeless and marginally housed women experience in health service utilization and health status. To achieve these specific aims, the following activities will be accomplished: 1) recruit an additional 50 women into a preexisting cohort in order to increase statistical power for gender comparisons; (2) add detailed drug use, health, victimization, subsistence needs, and health service utilization variables to the existing REACH questionnaire; (3) implement a new SCID diagnostic assessment to thoroughly assess mental health; (4) employ the use of electronic health service databases to conduct new validity studies; and (5) conduct analyses specific to these new areas of interest. Achieving the proposed specific aims will only be possible with the addition of these new activities that will ultimately yield a new class of analyses. A detailed study of the impact and interactions of gender, drug use, mental illness, health service use, competing needs like access to food, and health status will lead to a better understanding of ongoing mortality among HIV-infected marginally housed individuals and create the foundation for more effective health interventions in a variety of settings.