A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

Jodie L. Guest, Amy C. Weintrob, David Rimland, Christopher Rentsch, William P. Bradley, Brian K. Agan, Vincent C. Marconi, Susan Banks, Mary Bavaro, Ionut Bebu, Helen Chun, Nancy Crum-Cianflone, Cathy Decker, Conner Eggleston, Tomas Ferguson, Susan Fraser, Joshua Hartzell, Joshua Hawley, Gunther Hsue, Arthur Johnson & 17 others Mark G Kortepeter, Tahaniyat Lalani, Robbin Lockhart, Grace Macalinio, Scott Merritt, Octavio Mesner, Robert O'Connell, Maj Jason Okulicz, Sheila Peel, Michael Polis, John Powers, Roseanne Ressner, Edmund Tramont, Tyler Warkentien, Amy Weintrob, Timothy Whitman, Michael Zapor

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Introduction: The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. Methods: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. Results: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables. Conclusion: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

Original languageEnglish (US)
Article numbere62273
JournalPloS one
Volume8
Issue number5
DOIs
StatePublished - May 1 2013

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veterans
Highly Active Antiretroviral Therapy
Veterans
Natural History
cohort studies
natural history
Cohort Studies
HIV
Costs
health services
demographic statistics
homeless people
substance abuse
Acquired Immunodeficiency Syndrome
unemployment
Survival Analysis
Mortality
drug therapy
socioeconomics
Demography

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS). / Guest, Jodie L.; Weintrob, Amy C.; Rimland, David; Rentsch, Christopher; Bradley, William P.; Agan, Brian K.; Marconi, Vincent C.; Banks, Susan; Bavaro, Mary; Bebu, Ionut; Chun, Helen; Crum-Cianflone, Nancy; Decker, Cathy; Eggleston, Conner; Ferguson, Tomas; Fraser, Susan; Hartzell, Joshua; Hawley, Joshua; Hsue, Gunther; Johnson, Arthur; Kortepeter, Mark G; Lalani, Tahaniyat; Lockhart, Robbin; Macalinio, Grace; Merritt, Scott; Mesner, Octavio; O'Connell, Robert; Okulicz, Maj Jason; Peel, Sheila; Polis, Michael; Powers, John; Ressner, Roseanne; Tramont, Edmund; Warkentien, Tyler; Weintrob, Amy; Whitman, Timothy; Zapor, Michael.

In: PloS one, Vol. 8, No. 5, e62273, 01.05.2013.

Research output: Contribution to journalArticle

Guest, JL, Weintrob, AC, Rimland, D, Rentsch, C, Bradley, WP, Agan, BK, Marconi, VC, Banks, S, Bavaro, M, Bebu, I, Chun, H, Crum-Cianflone, N, Decker, C, Eggleston, C, Ferguson, T, Fraser, S, Hartzell, J, Hawley, J, Hsue, G, Johnson, A, Kortepeter, MG, Lalani, T, Lockhart, R, Macalinio, G, Merritt, S, Mesner, O, O'Connell, R, Okulicz, MJ, Peel, S, Polis, M, Powers, J, Ressner, R, Tramont, E, Warkentien, T, Weintrob, A, Whitman, T & Zapor, M 2013, 'A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)', PloS one, vol. 8, no. 5, e62273. https://doi.org/10.1371/journal.pone.0062273
Guest, Jodie L. ; Weintrob, Amy C. ; Rimland, David ; Rentsch, Christopher ; Bradley, William P. ; Agan, Brian K. ; Marconi, Vincent C. ; Banks, Susan ; Bavaro, Mary ; Bebu, Ionut ; Chun, Helen ; Crum-Cianflone, Nancy ; Decker, Cathy ; Eggleston, Conner ; Ferguson, Tomas ; Fraser, Susan ; Hartzell, Joshua ; Hawley, Joshua ; Hsue, Gunther ; Johnson, Arthur ; Kortepeter, Mark G ; Lalani, Tahaniyat ; Lockhart, Robbin ; Macalinio, Grace ; Merritt, Scott ; Mesner, Octavio ; O'Connell, Robert ; Okulicz, Maj Jason ; Peel, Sheila ; Polis, Michael ; Powers, John ; Ressner, Roseanne ; Tramont, Edmund ; Warkentien, Tyler ; Weintrob, Amy ; Whitman, Timothy ; Zapor, Michael. / A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS). In: PloS one. 2013 ; Vol. 8, No. 5.
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abstract = "Introduction: The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. Methods: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. Results: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5{\%} to 1.6{\%} (mortality only) and 26.8{\%} to 4.1{\%} (combined mortality or AIDS) when controlling for clinical and demographic variables. Conclusion: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.",
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AU - Guest, Jodie L.

AU - Weintrob, Amy C.

AU - Rimland, David

AU - Rentsch, Christopher

AU - Bradley, William P.

AU - Agan, Brian K.

AU - Marconi, Vincent C.

AU - Banks, Susan

AU - Bavaro, Mary

AU - Bebu, Ionut

AU - Chun, Helen

AU - Crum-Cianflone, Nancy

AU - Decker, Cathy

AU - Eggleston, Conner

AU - Ferguson, Tomas

AU - Fraser, Susan

AU - Hartzell, Joshua

AU - Hawley, Joshua

AU - Hsue, Gunther

AU - Johnson, Arthur

AU - Kortepeter, Mark G

AU - Lalani, Tahaniyat

AU - Lockhart, Robbin

AU - Macalinio, Grace

AU - Merritt, Scott

AU - Mesner, Octavio

AU - O'Connell, Robert

AU - Okulicz, Maj Jason

AU - Peel, Sheila

AU - Polis, Michael

AU - Powers, John

AU - Ressner, Roseanne

AU - Tramont, Edmund

AU - Warkentien, Tyler

AU - Weintrob, Amy

AU - Whitman, Timothy

AU - Zapor, Michael

PY - 2013/5/1

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N2 - Introduction: The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. Methods: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. Results: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables. Conclusion: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

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