Self-reported health-related quality of life in persons with HIV infection: results from a multi-site interview project

BACKGROUND: To examine demographic and behavioral associations with self-reported health-related quality of life (HRQOL) among persons with HIV infection or AIDS. METHODS: Analysis of interviews with persons ≥ 18 years of age reported through routine disease surveillance with HIV infection or AIDS to nine state and local health departments from January 1995 through December 1996. Scales were constructed from validated measures of HRQOL, and mean scores were calculated (lower scores signified poorer HRQOL). Measures of HRQOL included Overall Health, Pain, Physical Functioning, Role Functioning, Social Functioning, Mental Health, Energy/Fatigue, and Cognitive Functioning. Differences in HRQOL were examined by various demographic and behavioral factors, including taking antiretroviral medication. RESULTS: HRQOL data were available for 3778 persons. Factors associated with lower HRQOL scores included older age, female sex, black or Hispanic race/ethnicity, injection drug use, lower education and income, no private health insurance, and lower CD4 count. In multivariate analysis, lower CD4 count was the factor most consistently associated with lower HRQOL. Taking antiretroviral medication was not associated with differences in HRQOL regardless of CD4 count. CONCLUSIONS: Perception of HRQOL varied in a population with HIV infection or AIDS. On most HRQOL measures, lower CD4 count was associated with lower HRQOL. Measurement of HRQOL can assist in understanding the long-term effects of disease and treatment on persons with HIV

Improving the Representativeness of Behavioral and Clinical Surveillance for Persons with HIV in the United States: The Rationale for Developing a Population-Based Approach

The need for a new surveillance approach to understand the clinical outcomes and behaviors of people in care for HIV evolved from the new challenges for monitoring clinical outcomes in the HAART era, the impact of the epidemic on an increasing number of areas in the US, and the need for representative data to describe the epidemic and related resource utilization and needs. The Institute of Medicine recommended that the Centers for Disease Control and Prevention and the Heath Resources and Services Administration coordinate efforts to survey a random sample of HIV-infected persons in care, in order to more accurately measure the need for prevention and care services. The Medical Monitoring Project (MMP) was created to meet these needs. This manuscript describes the evolution and design of MMP, a new nationally representative clinical outcomes and behavioral surveillance system, and describes how MMP data will be used locally and nationally to identify care and treatment utilization needs, and to plan for prevention interventions and services

Male Circumcision for Prevention of HIV Transmission: What the New Data Mean for HIV Prevention in the United States

Recent clinical trials in Africa found that male circumcision reduces the risk of acquiring HIV from heterosexual sex--what are the implications of these studies for the United States

Patient and Regimen Characteristics Associated with Self-Reported Nonadherence to Antiretroviral Therapy

BACKGROUND: Nonadherence to antiretroviral therapy (ARVT) is an important behavioral determinant of the success of ARVT. Nonadherence may lead to virological failure, and increases the risk of development of drug resistance. Understanding the prevalence of nonadherence and associated factors is important to inform secondary HIV prevention efforts. METHODOLOGY/PRINCIPAL FINDINGS: We used data from a cross-sectional interview study of persons with HIV conducted in 18 U.S. states from 2000-2004. We calculated the proportion of nonadherent respondents (took <95% of prescribed doses in the past 48 hours), and the proportion of doses missed. We used multivariate logistic regression to describe factors associated with nonadherence. Nine hundred and fifty-eight (16%) of 5,887 respondents reported nonadherence. Nonadherence was significantly (p<0.05) associated with black race and Hispanic ethnicity; age <40 years; alcohol or crack use in the prior 12 months; being prescribed >or=4 medications; living in a shelter or on the street; and feeling "blue" >or=14 of the past 30 days. We found weaker associations with having both male-male sex and injection drug use risks for HIV acquisition; being prescribed ARVT for >or=21 months; and being prescribed a protease inhibitor (PI)-based regimen not boosted with ritonavir. The median proportion of doses missed was 50%. The most common reasons for missing doses were forgetting and side effects. CONCLUSIONS/SIGNIFICANCE: Self-reported recent nonadherence was high in our study. Our data support increased emphasis on adherence in clinical settings, and additional research on how providers and patients can overcome barriers to adherence

An Ecological Analysis of the Impact of Temperature Inversion on Emergency Department Visits for Respiratory Syndromes and Subsyndromes using BioSense 2.0 Frontend Data

This analysis used BioSense 2.0 frontend data to evaluate the impact of air quality indeces on emergency department visits for respiratory syndromes and subsyndromes during wintertime inversions in Salt Lake County, UT. Most syndromes and subsyndromes occurred more frequently on days with higher AQI and aberration alarms were more likely to be triggered on days with higher AQI for ILI, pleurisy, and respiratory failure. After adjusting for seasonality, the AQI was significantly associated with the proportion of emergency room visits for RSV, ILI, and the respiratory syndrome. These results suggest frontend data may be useful for ecological air quality analyses

An Evaluation of the Biosense 2.0 “Poisoning by Medicines” Syndrome Using Chief-Complaint Data in Utah

Utilization of the BioSense 2.0 system for syndromic surveillance requires validating syndromes for sensitivity and specificity. The objective of this presentation is to evaluate the BioSense 2.0 poisoning by medicines syndrome by determining chief complaint terms for inclusion and exclusion based upon pre-defined ICD-9 codes and a comparison of binned and unbinned chief complaint data. The results of this study suggest that the inclusion of the chief complaint terms "od," "overmedicated," and "ingested" will increase sensitivity, while the exclusion of terms related to alcohol, carbon monoxide, and food poisoning; swallowing a foreign body; and contact dermatitis will increase specificity

Piloting Electronic Case Reporting for Improved Surveillance of Sexually Transmitted Diseases in Utah

Objectives: The Utah Department of Health (UDOH) developed an electronic case reporting (eCR) process to automatically transfer clinical data from a provider to the state health department, with aims of improving sexually transmitted disease (STD) surveillance data quality, decreasing the time spent on STD case investigations, and expanding the process to other diseases and larger healthcare systems.Methods: Reportable Conditions Trigger Codes (RCTC) were placed into the electronic health record (EHR) system at Planned Parenthood Association of Utah (PPAU) to trigger the automatic transfer of clinical data to Utah’s public health surveillance system. Received data were deduplicated, processed, and assigned directly to the public health surveillance system, with minimal manual intervention.Results: Eighteen new data elements, important for STD case investigations, were transferred to cases with eCR. Additionally, the clinical time spent transmitting data was vastly reduced. With the new eCR process more complete and timely data is received by public health. Providers, as well as public health, now spend less time manually transmitting clinical data by fax and/or phone.Discussion: Automated processes are challenging but can be achieved with a robust disease surveillance system, flexible rules engine, skillful programming, on-going analysis, and successful partnerships. The eCR process created for this project can potentially be useful for other conditions outside of STDs.Conclusion: Results of this demonstration project offer an opportunity for readers to learn about eCR and apply lessons learned to improve their existing eCR systems, or future public health informatics initiatives, at any state-level jurisdiction

Evaluating Ascertainment of Hepatitis C Cases and Deaths by Electronically Linking Surveillance and Vital Statistics Data in Utah

Although chronic hepatitis C virus (HCV) infection results in substantial morbidity and mortality, many cases are undiagnosed and reporting to public health is often incomplete. To determine how well surveillance data documents deaths due to HCV, we linked reported HCV cases to death certificate records. Electronic record linkage found 346 deaths and an additional 254 persons were identified as having chronic HCV as a cause of death that had never been reported to public health. These results suggest that enhanced surveillance is needed to allow for more accurate representation of prevalence and mortality trends amongst the HCV population in Utah

HIV/AIDS among minority races and ethnicities in the United States, 1999-2003.

HIV/AIDS disproportionately affects minority races and ethnicities in the United States. To reduce rates of HIV/AIDS in these populations, effective and culturally appropriate prevention interventions must be developed and implemented