National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Alcohol Use (1)
- Care Management (1)
- Children/Adolescents (2)
- Chronic Conditions (3)
- Clinical Decision Support (CDS) (2)
- Clinician-Patient Communication (4)
- Communication (2)
- Comparative Effectiveness (1)
- Depression (2)
- Diabetes (1)
- Diagnostic Safety and Quality (4)
- Disparities (3)
- Education: Academic (1)
- Education: Patient and Caregiver (2)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (1)
- Guidelines (1)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (3)
- Healthcare Delivery (2)
- Healthcare Utilization (1)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (2)
- Health Insurance (4)
- Heart Disease and Health (2)
- Hepatitis (2)
- Hospitalization (3)
- Hospital Readmissions (1)
- (-) Human Immunodeficiency Virus (HIV) (51)
- Infectious Diseases (1)
- Injuries and Wounds (1)
- Lifestyle Changes (1)
- Low-Income (1)
- Medicaid (6)
- Medicare (3)
- Medication (10)
- Men's Health (1)
- Mortality (1)
- Nutrition (1)
- Obesity: Weight Management (1)
- Outcomes (1)
- Pain (1)
- Palliative Care (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Patient Adherence/Compliance (7)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Self-Management (1)
- Policy (2)
- Pregnancy (1)
- Prevention (5)
- Provider (1)
- Public Health (2)
- Quality of Life (1)
- Racial and Ethnic Minorities (12)
- Respiratory Conditions (2)
- Risk (6)
- Screening (4)
- Social Determinants of Health (1)
- Social Stigma (4)
- Substance Abuse (3)
- Tobacco Use (1)
- Uninsured (1)
- Urban Health (5)
- Vulnerable Populations (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 51 Research Studies DisplayedFarmer C, Yehia BR, Fleishman JA
AHRQ Author: Fleishman JA
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network.
The researchers evaluated the clinical and demographic characteristics of non-perinatally HIV (nPHIV)-infected youth associated with retention in care 1 year after initiating care and in the 2 years thereafter. They concluded that patients who were Hispanic, were men who have sex with men, or were seen at pediatric clinics were more likely to be retained in care.
AHRQ-authored.
Citation: Farmer C, Yehia BR, Fleishman JA .
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network.
J Pediatric Infect Dis Soc 2016 Mar;5(1):39-46. doi: 10.1093/jpids/piu102.
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Keywords: Healthcare Delivery, Children/Adolescents, Human Immunodeficiency Virus (HIV), Risk, Racial and Ethnic Minorities
Morgan E, Skaathun B, Michaels S
Marijuana use as a sex-drug is associated with HIV risk among black MSM and their network.
Little attention has been paid to marijuana use among black men who have sex with men and its potential for HIV risk. This study found that respondents with a moderate or high perception of network members who use marijuana were more likely to use marijuana both in general and as a sex-drug.
AHRQ-funded; HS000084.
Citation: Morgan E, Skaathun B, Michaels S .
Marijuana use as a sex-drug is associated with HIV risk among black MSM and their network.
AIDS Behav 2016 Mar;20(3):600-7. doi: 10.1007/s10461-015-1195-7.
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Keywords: Human Immunodeficiency Virus (HIV), Racial and Ethnic Minorities, Lifestyle Changes
Berry SA, Fleishman JA, Moore RD
AHRQ Author: Fleishman JA
Thirty-day hospital readmissions for adults with and without HIV infection.
This study compared 30-day readmission rates by HIV status in a multi-state sample with planned subgroup comparisons by insurance and diagnostic categories. After adjustment for age, gender, race, insurance, and diagnostic category, HIV infection was associated with 1.5 times higher odds of readmission. Predicted, adjusted readmission rates were higher for persons living with HIV within every insurance category, including Medicaid.
AHRQ-authored.
Citation: Berry SA, Fleishman JA, Moore RD .
Thirty-day hospital readmissions for adults with and without HIV infection.
HIV Med 2016 Mar;17(3):167-77. doi: 10.1111/hiv.12287.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Human Immunodeficiency Virus (HIV), Hospital Readmissions, Medicaid, Medicare
Flickinger TE, Saha S, Roter D
Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care.
The researchers examined associations of clinicians' empathy with patient-clinician communication behaviors, patients' rating of care, and medication self-efficacy. They found that clinicians in the highest vs. lowest empathy tertile engaged in less explicitly emotional talk, while clinicians in the middle vs. lowest engaged in more positive talk, more questions, and more patient activating talk, while patients of higher empathy clinicians disclosed more psychosocial and biomedical information. They further found that patients of clinicians in both the middle and highest (vs. lowest) empathy tertiles had greater odds of reporting highest medication self-efficacy.
AHRQ-funded; HS013903.
Citation: Flickinger TE, Saha S, Roter D .
Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care.
Patient Educ Couns 2016 Feb;99(2):220-6. doi: 10.1016/j.pec.2015.09.001.
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Keywords: Communication, Human Immunodeficiency Virus (HIV), Medication, Patient Adherence/Compliance, Clinician-Patient Communication
Flickinger TE, Saha S, Roter D
Respecting patients is associated with more patient-centered communication behaviors in clinical encounters.
The researchers investigated whether respect for patients was associated with communication behaviors during HIV care encounters. They found that respect is associated with positive and patient-centered communication behaviors during encounters. They recommended that clinicians should be mindful of their respectful attitudes and work to foster positive regard for patients.
AHRQ-funded; HS013903.
Citation: Flickinger TE, Saha S, Roter D .
Respecting patients is associated with more patient-centered communication behaviors in clinical encounters.
Patient Educ Couns 2016 Feb;99(2):250-5. doi: 10.1016/j.pec.2015.08.020.
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Keywords: Human Immunodeficiency Virus (HIV), Patient-Centered Healthcare, Patient and Family Engagement, Patient Experience, Clinician-Patient Communication
Depp TB, McGinnis KA, Kraemer K
Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients.
This study sought to determine the association between HIV infection and other risk factors for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). It concluded that HIV infection, especially with lower CD4 cell count, is an independent risk factor for AECOPD. Enhanced susceptibility to harm from current smoking or unhealthy alcohol use in HIV-infected patients may also contribute to the greater rate of AECOPD.
AHRQ-funded; HS023258.
Citation: Depp TB, McGinnis KA, Kraemer K .
Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients.
AIDS 2016 Jan 28;30(3):455-63. doi: 10.1097/qad.0000000000000940.
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Keywords: Respiratory Conditions, Human Immunodeficiency Virus (HIV), Risk, Substance Abuse, Tobacco Use
Bares S, Eavou R, Bertozzi-Villa C
Expanded HIV testing and linkage to care: Conventional vs. Point-of-care testing and assignment of patient notification and linkage to care to an HIV care program.
This study examined the X-TLC program that used standard blood-based laboratory testing vs. point-of-care rapid testing or rapid laboratory testing with point-of-care results notification. Site coordinators and the linkage-to-care coordinator oversaw testing, test notification, and linkage to care. It concluded that HIV screening and linkage to care can be accomplished by incorporating standard testing for HIV into routine medical care.
AHRQ-funded; HS022433.
Citation: Bares S, Eavou R, Bertozzi-Villa C .
Expanded HIV testing and linkage to care: Conventional vs. Point-of-care testing and assignment of patient notification and linkage to care to an HIV care program.
Public Health Rep 2016 Jan-Feb;131 Suppl 1:107-20.
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Keywords: Healthcare Delivery, Diagnostic Safety and Quality, Human Immunodeficiency Virus (HIV), Urban Health, Vulnerable Populations
Khanna AS, Michaels S, Skaathun B
Preexposure prophylaxis awareness and use in a population-based sample of young black men who have sex with men.
The researchers studied relevant characteristics of diverse young black men who have sex with men and their corresponding preexposure prophylaxis (PrEP) engagement. Their population-based cohort study illustrated that real-world PrEP use by those with the highest HIV incidence faces major implementation challenges that require purposeful and sustained engagement with black communities inclusive of their health care providers.
AHRQ-funded; HS000084.
Citation: Khanna AS, Michaels S, Skaathun B .
Preexposure prophylaxis awareness and use in a population-based sample of young black men who have sex with men.
JAMA Intern Med 2016 Jan;176(1):136-8. doi: 10.1001/jamainternmed.2015.6536..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Racial and Ethnic Minorities, Education: Patient and Caregiver
Earnshaw VA, Jin H, Wickersham JA
Stigma toward men who have sex with men among future healthcare providers in Malaysia: would more interpersonal contact reduce prejudice?
This study sought to inform interventions to reduce stigma toward men who have sex with men (MSM) living in countries with strong stigma toward MSM, particularly among healthcare providers. It found that multivariate analyses of variance suggest that medical and dental students who had interpersonal contact with MSM were less prejudiced toward and had lower intentions to discriminate against MSM.
AHRQ-funded; HS022986.
Citation: Earnshaw VA, Jin H, Wickersham JA .
Stigma toward men who have sex with men among future healthcare providers in Malaysia: would more interpersonal contact reduce prejudice?
AIDS Behav 2016 Jan;20(1):98-106. doi: 10.1007/s10461-015-1168-x.
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Keywords: Education: Academic, Human Immunodeficiency Virus (HIV), Provider, Clinician-Patient Communication, Social Stigma
Rhodes RL, Nazir F, Lopez S
Use and predictors of end-of-life care among HIV patients in a safety net health system.
The authors examined completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital. They found that the rates of advance directive completion, palliative care use, and hospice use were low. They recommended that advances should be made in identifying those patients earlier in their disease trajectories.
AHRQ-funded; HS022418.
Citation: Rhodes RL, Nazir F, Lopez S .
Use and predictors of end-of-life care among HIV patients in a safety net health system.
J Pain Symptom Manage 2016 Jan;51(1):120-5. doi: 10.1016/j.jpainsymman.2015.08.010.
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Keywords: Human Immunodeficiency Virus (HIV), Palliative Care, Urban Health
Turan B, Stringer KL, Onono M
Linkage to HIV care, postpartum depression, and HIV-related stigma in newly diagnosed pregnant women living with HIV in Kenya: a longitudinal observational study.
The investigators examined associations between linkage to HIV care, postpartum depression, and internalized stigma in a population with a high risk of depression: newly diagnosed HIV-positive pregnant women. They found that, in this study group of women from rural Kenya, at 6 weeks postpartum, those who had not linked to HIV care after testing positive at their first antenatal visit had higher levels of depression and internalized stigma, compared to women who had linked to care. Internalized stigma mediated the effect of linkage to care on depression. Furthermore, participants who had both linked to HIV care and initiated antiretroviral therapy reported the lowest levels of depressive symptoms.
AHRQ-funded; HS013852.
Citation: Turan B, Stringer KL, Onono M .
Linkage to HIV care, postpartum depression, and HIV-related stigma in newly diagnosed pregnant women living with HIV in Kenya: a longitudinal observational study.
BMC Pregnancy Childbirth 2014 Dec 3;14:400. doi: 10.1186/s12884-014-0400-4.
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Keywords: Depression, Human Immunodeficiency Virus (HIV), Pregnancy, Social Stigma
Merlin JS, Walcott M, Ritchie C
'Two pains together': patient perspectives on psychological aspects of chronic pain while living with HIV.
The researchers’ objective was to explore HIV-infected patients’ perspectives on psychological aspects of chronic pain using in-depth qualitative interviews. Key themes that emerged included the close relationship between mood and pain; mood and pain in the context of living with HIV; use of alcohol/drugs to self-medicate for pain; and the challenge of receiving prescription pain medications while dealing with substance use disorders.
AHRQ-funded; HS021694.
Citation: Merlin JS, Walcott M, Ritchie C .
'Two pains together': patient perspectives on psychological aspects of chronic pain while living with HIV.
PLoS One 2014 Nov 3;9(11):e111765. doi: 10.1371/journal.pone.0111765..
Keywords: Care Management, Chronic Conditions, Human Immunodeficiency Virus (HIV), Pain, Patient-Centered Outcomes Research, Patient Self-Management
Haukoos JS, Lyons MS, White DA
Acute HIV infection and implications of fourth-generation HIV screening in emergency departments.
This editorial discusses a study in the same journal issue that contributes substantially to the understanding of HIV screening in EDs by reporting programmatic results of nontargeted opt-out screening in a high-volume, urban ED. This study is unique in that it reports, for the first time in an ED setting, the use of fourth-generation HIV testing which improves detection of acute HIV infection.
AHRQ-funded; HS021749.
Citation: Haukoos JS, Lyons MS, White DA .
Acute HIV infection and implications of fourth-generation HIV screening in emergency departments.
Ann Emerg Med 2014 Nov;64(5):547-51. doi: 10.1016/j.annemergmed.2014.07.004..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Emergency Department, Urban Health
Abara WE, Smith L, Zhang S
The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS.
In this article, the investigators examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (>/= 50 years) people living with HIV/AIDS (PLWHA). The investigators concluded that comorbidities affected timely ART initiation in older PLWHA. They asserted that older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to this population.
AHRQ-funded; HS019470.
Citation: Abara WE, Smith L, Zhang S .
The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS.
Am J Public Health 2014 Nov;104(11):e135-41. doi: 10.2105/ajph.2014.302227..
Keywords: Elderly, Human Immunodeficiency Virus (HIV), Racial and Ethnic Minorities
Sentell T, Marten L, Ahn HJ
Disparities in hospitalizations among HIV positive individuals for native Hawaiians and Asians compared to whites in Hawaii.
This study investigated characteristics and disparities in hospitalizations among HIV positive individuals for Asian American subgroups and Native Hawaiians using data from all hospitalizations in Hawai‘i between December 2006 and December 2010. It concluded that disparities appear to exist in rates of hospitalizations among HIV positive individuals for Native Hawaiians and Asians, as well as in the demographic and, to some degree, the clinical characteristics of those hospitalized.
AHRQ-funded; HS019990.
Citation: Sentell T, Marten L, Ahn HJ .
Disparities in hospitalizations among HIV positive individuals for native Hawaiians and Asians compared to whites in Hawaii.
Hawaii J Med Public Health 2014 Oct;73(10):308-14..
Keywords: Hospitalization, Human Immunodeficiency Virus (HIV), Disparities, Racial and Ethnic Minorities, Patient-Centered Outcomes Research
Yehia BR, Fleishman JA, Agwu AL
AHRQ Author: Fleishman JA
Health insurance coverage for persons in HIV care, 2006-2012.
The authors examined trends in health insurance coverage at 11 US HIV clinics between 2006 and 2012. They found that Medicaid coverage was more prevalent among women than men; blacks and Hispanics than whites; and individuals with injection drug use risk compared with other transmission risk factors, with Hispanics and younger age groups more likely to be uninsured than other racial/ethnic and older age groups, respectively.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Yehia BR, Fleishman JA, Agwu AL .
Health insurance coverage for persons in HIV care, 2006-2012.
J Acquir Immune Defic Syndr 2014 Sep 1;67(1):102-6. doi: 10.1097/qai.0000000000000251.
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Keywords: Health Insurance, Human Immunodeficiency Virus (HIV), Medicare, Racial and Ethnic Minorities, Uninsured
Haines CF, Fleishman JA, Yehia BR
AHRQ Author: Fleishman JA
Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era.
The authors sought to determine whether the CD4 count at presentation, a surrogate for time to presentation, increased from 2003 to 2011. They demonstrated a small, but statistically significant, increase in CD4 at presentation after the 2006 CDC HIV-screening guideline revision.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Haines CF, Fleishman JA, Yehia BR .
Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era.
J Acquir Immune Defic Syndr 2014 Sep 1;67(1):84-90. doi: 10.1097/qai.0000000000000228.
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Keywords: Diagnostic Safety and Quality, Human Immunodeficiency Virus (HIV)
Kelly JD, Hartman C, Graham J
Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study.
The researchers studied 168 persons newly diagnosed with AIDS to determine if social support contributes to various aspects of HIV care. They found that higher social support scores were associated with earlier HIV diagnosis, linkage to care, and adherence to antiretroviral therapy (ART). However, social support did not contribute to use of ART or retention in HIV care.
AHRQ-funded; HS016093
Citation: Kelly JD, Hartman C, Graham J .
Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study.
J Assoc Nurses AIDS Care. 2014 Sep-Oct;25(5):405-13. doi: 10.1016/j.jana.2013.12.002..
Keywords: Human Immunodeficiency Virus (HIV), Patient Adherence/Compliance, Diagnostic Safety and Quality
Yehia BR, Herati RS, Fleishman JA
AHRQ Author: Fleishman JA
Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts.
The authors sought to understand hepatitis C virus (HCV) testing practices in people living with HIV (PLWH) in order to improve compliance with guidelines and help identify areas for future intervention. They concluded that additional efforts to improve compliance with HCV testing guidelines are needed.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Yehia BR, Herati RS, Fleishman JA .
Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts.
PLoS One 2014 Jul 17;9(7):e102766. doi: 10.1371/journal.pone.0102766.
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Keywords: Guidelines, Healthcare Utilization, Hepatitis, Human Immunodeficiency Virus (HIV), Screening
Laws MB, Lee Y, Rogers WH
Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity.
This study directly examined differences in provider–patient communication about anti-retroviral therapy (ART) adherence by patient race or ethnicity. It found more ART adherence dialogue with Black and Hispanic patients than with White patients, even after controlling for indications, and a tendency for adherence dialogue to be more directive in Hispanics than in Whites.
AHRQ-funded; 290010012.
Citation: Laws MB, Lee Y, Rogers WH .
Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity.
AIDS Behav 2014 Jul;18(7):1279-87. doi: 10.1007/s10461-014-0697-z..
Keywords: Human Immunodeficiency Virus (HIV), Clinician-Patient Communication, Patient Adherence/Compliance, Racial and Ethnic Minorities
Hsieh YH, Haukoos JS, Rothman RE
Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED.
The researchers sought to evaluate the performance of a short version of the Denver HIV Risk Score in 2 urban emergency departments. They found that external validation resulted in good discrimination. The study cohort included 15,184 patients with newly diagnosed HIV infection.
AHRQ-funded; HS017526
Citation: Hsieh YH, Haukoos JS, Rothman RE .
Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED.
Am J Emerg Med. 2014 Jul;32(7):775-9. doi: 10.1016/j.ajem.2014.02.043..
Keywords: Emergency Medical Services (EMS), Human Immunodeficiency Virus (HIV), Risk, Urban Health
Zhang SM, McGoy SL, Dawes D
The potential for elimination of racial-ethnic disparities in HIV treatment initiation in the Medicaid population among 14 southern states.
This study explored racial/ethnic disparities in the initiation of antiretroviral treatment among HIV-infected Medicaid enrollees in 14 Southern States. It found no significant differences between blacks and non-Hispanic whites but Hispanic/Latino persons were significantly less likely to receive antiretroviral treatment.
AHRQ-funded; HS022444; HS019470
Citation: Zhang SM, McGoy SL, Dawes D .
The potential for elimination of racial-ethnic disparities in HIV treatment initiation in the Medicaid population among 14 southern states.
PLoS One. 2014 Apr 25;9(4):e96148. doi: 10.1371/journal.pone.0096148..
Keywords: Human Immunodeficiency Virus (HIV), Disparities, Racial and Ethnic Minorities, Medicaid
Crane HM, Heckbert SR, Drozd DR
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
In this study, a team of researchers developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. They found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half the events ultimately determined to be MIs were not identified by clinical diagnoses.
AHRQ-funded; HS019515
Citation: Crane HM, Heckbert SR, Drozd DR .
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
Am J Epidemiol. 2014 Apr 15;179(8):996-1005. doi: 10.1093/aje/kwu010..
Keywords: Human Immunodeficiency Virus (HIV), Heart Disease and Health, Clinical Decision Support (CDS), Diagnostic Safety and Quality
Agwu AL, Neptune A, Voss C
CD4 counts of nonperinatally HIV-infected youth and young adults presenting for HIV care between 2002 and 2010.
This study of nonperinatally HIV-infected 12- to 24-year-olds presenting for care at HIV Research Network (HIVRN) sites between 2002 and 2010 sought to determine if fewer nPHIV–infected youth are presenting for care at lower CD4 counts. It found that the proportion of nPHIV-infected youth presenting to HIVRN sites with a CD4 count less than 350 cells/mm3 remained essentially unchanged between 2002 and 2010.
AHRQ-funded; 290010012.
Citation: Agwu AL, Neptune A, Voss C .
CD4 counts of nonperinatally HIV-infected youth and young adults presenting for HIV care between 2002 and 2010.
JAMA Pediatr 2014 Apr;168(4):381-3. doi: 10.1001/jamapediatrics.2013.4531..
Keywords: Human Immunodeficiency Virus (HIV), Children/Adolescents, Evidence-Based Practice
Yehia BR, French B, Fleishman JA
AHRQ Author: Fleishman JA
Retention in care is more strongly associated with viral suppression in HIV-infected patients with lower versus higher CD4 counts.
The investigators evaluated whether the association between retention in care and viral suppression differed by HIV disease severity. They found that retention in care is more strongly associated with viral suppression in patients with lower CD4 counts. They concluded that their results have important implications for improving the health of patients with advanced HIV disease and for test and treat approaches to HIV prevention.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Yehia BR, French B, Fleishman JA .
Retention in care is more strongly associated with viral suppression in HIV-infected patients with lower versus higher CD4 counts.
J Acquir Immune Defic Syndr 2014 Mar;65(3):333-9. doi: 10.1097/qai.0000000000000023.
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Keywords: Human Immunodeficiency Virus (HIV), Medication, Patient Adherence/Compliance