Publications
Department of Medicine faculty members published more than 3,000 peer-reviewed articles in 2022.
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2008
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2008
AIM
Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH).
DESIGN, SETTING AND PARTICIPANTS
A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months.
INTERVENTION
A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care.
MEASUREMENTS
An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use.
FINDINGS
Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition.
CONCLUSIONS
A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH.
View on PubMed2008
2008
The Fatigue Symptom Inventory has been used extensively to assess and measure fatigue in a number of clinical populations. The purpose of the present study was to further establish its utility by examining its operating characteristics and determining the optimal cutoff score for identifying clinically meaningful fatigue. The MOS 36-Item Short Form Vitality scale, a measure widely used to identify individuals with significant fatigue-related disability, was used to determine the sensitivity and specificity of the Fatigue Symptom Inventory. Results indicate that a score of 3 or greater on those items assessing fatigue in the past week is the optimal cutoff score for identifying clinically meaningful fatigue. Individuals who scored at or above the cutoff also reported significantly greater fatigue interference, more days of fatigue on average, and fatigue a greater proportion of each day in the past week. Findings suggest that the Fatigue Symptom Inventory can be used to discriminate effectively between individuals with and without clinically meaningful fatigue.
View on PubMed2008
2008
2008
2008
Antiretroviral (ARV) treatment interruptions are associated with virologic rebound, drug resistance, and increased morbidity and mortality. The Medicare Part D prescription drug benefit, implemented on January 1st, 2006, increased consumer cost-sharing. Consumer cost-sharing is associated with decreased access to medications and adverse clinical outcomes. We assessed the association of Part D implementation with treatment interruptions by studying 125 HIV-infected homeless and marginally housed individuals with drug coverage receiving ARV therapy. Thirty-five percent of respondents reported Medicare coverage and 11% reported ARV interruptions. The odds of ARV interruptions were six times higher among those with Part D coverage and remained significant after adjustment. The majority of Part D-covered respondents reporting ARV interruptions cited increased cost as their primary barrier. Directed interventions to monitor the long-term effects of increased cost burden on interruptions and clinical outcomes and to reduce cost burden are necessary to avoid preventable increases in morbidity and mortality.
View on PubMed