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Principal Investigator: Brianne Olivieri-Mui
Organization: NORTHEASTERN UNIVERSITY
Fiscal Year: 2024
Award: $123,254
Funding agency: National Institute on Aging
Project Summary
Antiretroviral therapy (ART) adherence among nursing home (NH) residents with HIV is less than optimal; in
the literature 21% of people with HIV had no ART from their NH, which is in contrast to the 87.5% adherence
among community dwelling older people with HIV. ART maintains viral suppression, prevents worsening of
chronic conditions and early mortality, and stopping ART is rarely indicated. Therefore optimal ART adherence
in the NH setting can only be achieved by understanding facilitators and barriers both documented in claims
and perceived by older people with HIV. This mixed methods study will assess ART adherence during the
community-to-long-stay-NH-transition period in three aims: Aim 1 will identify person-level, and NH-level,
factors associated with changes in ART adherence in socioeconomically diverse Medicare and Medicaid special
needs plan (SNP) claims. Aim 2 will assess perceptions and experiences of long-stay NH residents with HIV
through qualitative interviews and Aim 3 will examine concordant and discordant factors associated with ART
adherence by triangulation of Aims 1 and 2. Quantitative analyses will use two databases 1) Medicare 5%
enhanced sample; 2) claims from a New York City-based Medicaid HIV SNP. Logistic and linear regression
with generalized estimating equations will examine the change in ART adherence from the 6 months prior, to
the first three months after achieving NH long-stay status (1-year continuous enrollment). Subsequently,
qualitative interviews will focus on perspectives and experiences of people living with HIV aged 50+ with
regard to facilitators and barriers to ART adherence while they were a long-stay NH residents. Recruited
through two organizations, interviews will be semi-structured and analyzed with NVivo software using
inductive and deductive theory building through grounded theory analysis and until thematic saturation is met.
Triangulation using reconciliation and initiation techniques will address discordance between quantitative and
qualitative findings. The results will provide nuance beyond administrative claims data by including social
determinants and life course experiences (e.g., housing instability). This work will expand Dr Mui’s skills to
include Medicaid SNP data, qualitative and mixed-methods research. She will be supported by four co-mentors
with expertise in geriatrics, secondary data and qualitative and mixed-methods research, and health policy, in
addition to formal training through Northeastern University and related resources. This career development
award will complete Dr. Mui’s skills for researching hard to reach populations thereby helping establish her as
an independent researcher and leader in HIV and aging. It will also be foundational to future R01 research to
analyze healthcare utilization and health outcomes associated with ART adherence in the NH.
Terms: <AIDS Virus><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Adherence><Affect><Age><Aging><Amentia><Anti-Retroviral Agents><Application Context><Career Development Awards><Career Development Awards and Programs><Career Development Programs K-Series><Caring><Cessation of life><Characteristics><Chronic><Clinical><Communities><Computer software><Data><Data Bases><Data Set><Databases><Death><Dementia><Drug usage><Elderly><Enrollment><Ensure><Equation><Face><Future><Geriatrics><Goals><Guidelines><HIV><HIV Seronegativities><HIV Seronegativity><HIV negative><HTLV-III Seronegativities><HTLV-III Seronegativity><Health><Health Care Utilization><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Health Policy><Health Services Evaluation><Health Services Research><History><Home Nursing Care><Homelessness><Human Immunodeficiency Viruses><Individual><Intervention><Intervention Strategies><Interview><Investigators><K-Awards><K-Series Research Career Programs><Knowledge><LAV-HTLV-III><Life Cycle><Life Cycle Stages><Linear Regressions><Link><Literature><Logistic Regressions><Lymphadenopathy-Associated Virus><Medicaid><Medical Care Research><Medicare><Medicare claim><Medicare/Medicaid><Mentors><Mentorship><Methods><Modeling><New York><New York City><Non-Professional Home Care><Non-Professional Homecare><Nonprofessional Home Care><Nonprofessional Homecare><Nursing Homecare><Nursing Homes><Older Population><Outcome><Patients><Pattern><Perception><Persons><Policies><Population><QOC><Quality of Care><Recording of previous events><Reporting><Research><Research Career Program><Research Methodology><Research Methods><Research Personnel><Research Resources><Researchers><Resources><Risk><Sampling><Software><Special needs plan><Structure><Techniques><Testing><Time><Title 18><Training><Transmission><Universities><Viral><Virus-HIV><Work><advanced age><aged><ages><anti-retroviral><antiretroviral therapy><antiretroviral treatment><beneficiary><contextual factors><data base><design><designing><disability><drug use><enroll><experience><faces><facial><frailty><geriatric><geriatric medicine><health care policy><health care service use><health care service utilization><health insurance for disabled><healthcare policy><healthcare service use><healthcare service utilization><healthcare utilization><histories><homeless><housing instability><improved><instably housed><interventional strategy><life course><mortality><nursing home><nursing home days><nursing home length of stay><nursing home stay><older groups><older individuals><older person><prevent><preventing><recruit><research and methods><senior citizen><services research><sex related variation><sex variable><sex variation><sex-related variable><skills><social determinants><social disadvantage><social disparities><social health determinants><social inequality><socio-economic><socio-economically><sociodeterminant><socioeconomically><socioeconomics><theories><therapy adherence><therapy compliance><transmission process><unhoused><unstable housing><unstably housed><varies by sex>