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NRI 98-182 – HSR&D Study

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NRI 98-182
Predictors of Outcomes of HIV-Infected Males
Constance R. Uphold PhD MS BS
North Florida/South Georgia Veterans Health System, Gainesville, FL
Gainesville, FL
Funding Period: October 2000 - September 2005

BACKGROUND/RATIONALE:
Certain segments of the HIV-infected population, such as older, rural and nonwhite patients, progress to AIDS more rapidly than other subgroups. The goal of this project was to understand the reasons for these variations among vulnerable subgroups. The following three hypotheses were tested:
1. Age, rurality, and race/ethnicity are independently predictive of clinical outcomes (health-related quality of life [HRQOL], immunity, and viral load) over time.
2. Biopsychosocial variables (testosterone, body cell mass index, stress, health promoting behaviors, risk behaviors, social support) are independently predictive of clinical outcomes (HRQOL, immunity, viral load) over time.
3. Age, rurality, and race/ethnicity are independently predictive of the biopsychosocial variables (testosterone, body cell mass index, stress, health promoting behaviors, risk behaviors, social support) over time.

OBJECTIVE(S):
Certain segments of the HIV-infected population, such as older, rural and nonwhite patients, progress to AIDS more rapidly than other subgroups. The goal of this project was to understand the reasons for these variations among vulnerable subgroups. The following three hypotheses were tested:
1. Age, rurality, and race/ethnicity are independently predictive of clinical outcomes (health-related quality of life [HRQOL], immunity, and viral load) over time.
2. Biopsychosocial variables (testosterone, body cell mass index, stress, health promoting behaviors, risk behaviors, social support) are independently predictive of clinical outcomes (HRQOL, immunity, viral load) over time.
3. Age, rurality, and race/ethnicity are independently predictive of the biopsychosocial variables (testosterone, body cell mass index, stress, health promoting behaviors, risk behaviors, social support) over time.

METHODS:
This is a prospective cohort study of men attending three infectious disease clinics: VA medical center (n = 131), health department (n = 55), university hospital (n = 40). Data were collected from 226 men at baseline, 197 men at a 12-month follow-up, and 184 men at a 24-month follow up. Trained research assistants obtained information on stress (modified Psychiatric Epidemiological Research Interview), health promoting behaviors (Health Promoting Lifestyle Profile II), risk behaviors (selected items from national screening tools and previous HIV studies), social support (Social Support Appraisal), medication adherence (Patient Medication Adherence Questionnaire 7), comorbidity (Charlson Comorbidity Index Questionnaire) and health-related quality of life (HIV Cost & Services Utilization Study) with questionnaires. Subjects’ blood was analyzed for total and free testosterone and IL-6 at each time point. CD4 cells, memory CD4 cells, naïve CD4 cells and viral loads (HIV RNA levels) were measured every 3 months. Bioelectrical impedance analyses measured body cell mass index. Interaction terms were explored to determine varying effects of the independent varaibles on outcomes across time. Interactions were nonsignificant and thus, only the main effects were included in the models. Multivariate analysis was used to determine whether the independent varaibles were associated with the set of HRQOL outcomes after adjusting for covariates (i.e., education level, comorbidity, medication adherence, initial CD4 cell count, duration of HIV diagnosis). Then, analyses for each dependent variable were performed using General Linear Model (GLM) with repeated measures at all the time points.

FINDINGS/RESULTS:
This is a prospective cohort study of men attending three infectious disease clinics: VA medical center (n = 131), health department (n = 55), university hospital (n = 40). Data were collected from 226 men at baseline, 197 men at a 12-month follow-up, and 184 men at a 24-month follow up. Trained research assistants obtained information on stress (modified Psychiatric Epidemiological Research Interview), health promoting behaviors (Health Promoting Lifestyle Profile II), risk behaviors (selected items from national screening tools and previous HIV studies), social support (Social Support Appraisal), medication adherence (Patient Medication Adherence Questionnaire 7), comorbidity (Charlson Comorbidity Index Questionnaire) and health-related quality of life (HIV Cost & Services Utilization Study) with questionnaires. Subjects’ blood was analyzed for total and free testosterone and IL-6 at each time point. CD4 cells, memory CD4 cells, naïve CD4 cells and viral loads (HIV RNA levels) were measured every 3 months. Bioelectrical impedance analyses measured body cell mass index. Interaction terms were explored to determine varying effects of the independent varaibles on outcomes across time. Interactions were nonsignificant and thus, only the main effects were included in the models. Multivariate analysis was used to determine whether the independent varaibles were associated with the set of HRQOL outcomes after adjusting for covariates (i.e., education level, comorbidity, medication adherence, initial CD4 cell count, duration of HIV diagnosis). Then, analyses for each dependent variable were performed using General Linear Model (GLM) with repeated measures at all the time points.

IMPACT:
Surprisingly, age was the only socio-demographic factor associated with many positive factors (more health behaviors, less stress, better mental health). Professionals should concentrate on the positive aspects of aging with HIV and not view older age as a liability. Factors, which nurses can modify, were strongly associated with HRQOL outcomes. Programs are recommended to reduce stress and enhance social support and health behaviors, particularly for younger men who appear to be at greatest risk.

PUBLICATIONS:

Journal Articles

  1. Uphold CR, Shehan CL, Bender JM, Bender BS. Emotional bonds and social support exchange between men living with HIV infection and their mothers. American Journal of Men's Health. 2012 Mar 1; 6(2):97-107.
  2. Jeffries WL, Zsembik BA, Peek CW, Uphold CR. A longitudinal analysis of sociodemographic and health correlates of sexual health among HIV-infected men in the USA. Sexual health. 2009 Dec 1; 6(4):285-92.
  3. Bormann JE, Uphold CR, Maynard C. Predictors of complementary/alternative medicine use and intensity of use among men with HIV infection from two geographic areas in the United States. Journal of The Association of Nurses in AIDS Care. 2009 Nov 1; 20(6):468-80.
  4. Frame MW, Uphold CR, Shehan CL, Ried KJ. Longitudinal effects of spirituality on stress, depression and risk behaviors among men with HIV/AIDs. Journal of Spirituality in Mental Health. 2008 Feb 1; 10(2):145-168.
  5. Uphold CR, Holmes W, Reid K, Findley K, Parada JP. Healthy lifestyles and health-related quality of life among men living with HIV infection. Journal of The Association of Nurses in AIDS Care. 2007 Nov 1; 18(6):54-66.
  6. Jia H, Uphold CR, Zheng Y, Wu S, Chen GJ, Findley K, Duncan PW. A further investigation of health-related quality of life over time among men with HIV infection in the HAART era. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2007 Aug 1; 16(6):961-8.
  7. Mkanta WN, Uphold CR. Theoretical and methodological issues in conducting research related to health care utilization among individuals with HIV infection. AIDS Patient Care and Stds. 2006 Apr 1; 20(4):293-303.
  8. Cole SB, Langkamp-Henken B, Bender BS, Findley K, Herrlinger-Garcia KA, Uphold CR. Oxidative stress and antioxidant capacity in smoking and nonsmoking men with HIV/acquired immunodeficiency syndrome. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2005 Dec 1; 20(6):662-7.
  9. Frame MW, Uphold CR, Shehan CL, Reid KJ. The effects of spirituality on health-related quality of life in men with HIV/AIDS. Counseling and Values. 2005 Oct 5; 50(1):5-19.
  10. Tromble-Hoke SM, Langkamp-Henken B, Reid K, Hoffinger R, Uphold CR. Severe stress events and use of stress-management behaviors are associated with nutrition-related parameters in men with HIV/AIDS. Journal of the American Dietetic Association. 2005 Oct 1; 105(10):1541-8; quiz 1550.
  11. Uphold CR, Rane D, Reid K, Tomar SL. Mental health differences between rural and urban men living with HIV infection in various age groups. Journal of community health. 2005 Oct 1; 30(5):355-75.
  12. Jia H, Uphold CR, Wu S, Chen GJ, Duncan PW. Predictors of changes in health-related quality of life among men with HIV infection in the HAART era. AIDS Patient Care and Stds. 2005 Jun 1; 19(6):395-405.
  13. Shehan CL, Uphold CR, Bradshaw P, Bender JM, Arce N, Bender BS. To tell or not to tell: men's disclosure of their HIV-positive status to their mothers. Family Relations. 2005 Apr 1; 54(2):184-196.
  14. Burg MA, Uphold CR, Findley K, Reid K. Complementary and alternative medicine use among HIV-infected patients attending three outpatient clinics in the Southeastern United States. International Journal of STD & AIDS. 2005 Feb 1; 16(2):112-6.
  15. Jia H, Uphold CR, Wu S, Reid K, Findley K, Duncan PW. Health-related quality of life among men with HIV infection: effects of social support, coping, and depression. AIDS Patient Care and Stds. 2004 Oct 1; 18(10):594-603.
  16. Uphold CR, Deloria-Knoll M, Palella FJ, Parada JP, Chmiel JS, Phan L, Bennett CL. US hospital care for patients with HIV infection and pneumonia: the role of public, private, and Veterans Affairs hospitals in the early highly active antiretroviral therapy era. Chest. 2004 Feb 1; 125(2):548-56.
Conference Presentations

  1. Mkanta WN, Uphold CR. Longitudinal Study of Patient Satisfaction with Care in Men with HIV Infection. Paper presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.
  2. Jeffries WL, Peek CW, Zsembik B, Uphold CR. Sexual Intercourse, Quality Measures, and Dysfunction: Correlates of Sexual Health in HIV-Infected Men. Paper presented at: American Sociological Association Annual Meeting; 2006 Aug 12; Montréal, Canada.
  3. Jia H, Uphold CR, Zheng Y, Wu SS, Chen GJ, Duncan PW. The Impact of Psychosocial Factors and CD4 Count on HRQoL Change Among HIV-Infected Veterans. Poster session presented at: VA HSR&D National Meeting; 2006 Feb 16; Arlington, VA.
  4. Uphold CR, Arce N, Garzarella L. Aging and Mental Health Outcomes Among Men Living with HIV: Results of a Two-Year Study. Paper presented at: HIV / AIDS and Aging on HIV Over 50 National Conference; 2006 Jan 12; Miami, FL.
  5. Uphold CR, Zheng E, Van den, Jia H, Wu SS, Vogel WB, Duncan PW. Lifestyle Choices and Outcomes Among Men with HIV Infection: A Longitudinal Study. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2005 Dec 12; Philadelphia, PA.
  6. Uphold CR, Reid KJ. Biopsychosocial Outcomes Among Older and Younger Men with HIV Infection: A Longitudinal Analysis. Paper presented at: Southern Nurses Research Society Annual Conference; 2005 Feb 3; Atlanta, GA.
  7. Uphold CR, Reid KJ, Goodenow MM, Bender BS. Differences in Biological, Nutritional, and Psychosocial Characteristics Between Older and Younger Men with HIV Infection. Paper presented at: Association of Nurses in AIDS Care Annual Meeting; 2004 Nov 16; New Orleans, LA.
  8. Shehan CL, Uphold CR, Bender JM, Garzarella L. Emotional Bonds between Mothers and their HIV+ Sons. Paper presented at: National Council on Family Relations Annual Conference; 2004 Nov 1; Orlando, FL.
  9. Findley K, Uphold CR, Garzarella L. Sexual Health and Family Relationships Among Men Living with HIV Infections. Paper presented at: National Institute of Mental Health International Research Annual Conference; 2004 Jul 22; Atlanta, GA.
  10. Cole SB, Langkamp-Henken B, Uphold CR, Herrlinger-Garcia KA, Bender BS, Findley K, Hoffinger R. Oxidative stress and antioxidant capacity in smoking vs. nonsmoking men with HIV/AIDS. Paper presented at: Federation of American Societies for Experimental Biology Annual Meeting; 2004 Mar 24; Washington, DC.
  11. Hartzema AG, Uphold CR, Kwon S, Sinha K. Medication Adherence as a Predictor of Outcomes in HIV-Infected Men. Paper presented at: VA HSR&D National Meeting; 2004 Mar 10; Washington, DC.
  12. Uphold CR, Bender BS, Reid KJ. Mild, Moderate, and Severe HIV-Related Anemia: Risk Factors and Effects on Health-Related Quality of Life Outcomes. Paper presented at: Association of Nurses in AIDS Care Annual Meeting; 2003 Nov 7; San Francisco, CA.
  13. Uphold CR, Shehan CL, Bender BS, Bradshaw P. Patterns of Disclosure to Family Members Among HIV-Infected Men. Paper presented at: National Institute of Mental Health International Research Annual Conference; 2003 Jul 23; Washington, DC.
  14. Flaitz M, Uphold CR, Findley K, Reid KJ. Differences in Health Variables Between HIV-Infected and HCV-Co-infected Men. Paper presented at: Alpha Theta Chapter of Sigma Theta Tau International Annual Conference; 2003 Feb 21; Gainesville, FL.
  15. Holmes W, Uphold CR, Findley K, Reid KJ. Relationship between quality of life and health promoting behaviors, risk behaviors, and perceived stress in patients with HIV/AIDS. Paper presented at: Alpha Theta Chapter of Sigma Theta Tau International Annual Conference; 2003 Feb 21; Gainesville, FL.
  16. Uphold CR, Bender BS, Reid KJ, Findley K. HIV-Related Anemia Risk Factors and Effects on Health-Related Quality of Life Outcomes. Paper presented at: Alpha Theta Chapter of Sigma Theta Tau International Annual Conference; 2003 Feb 21; Gainesville, FL.
  17. Jia H, Uphold CR, Findley K, Wu SS, Reid KJ, Duncan PW. Health-Related Quality of Life in Veterans Living with HIV: The Role of Coping, Social Support, and Depression. Paper presented at: VA HSR&D National Meeting; 2003 Feb 14; Washington, DC.
  18. Uphold CR, Jia H, Reid KJ, Findley K. Effects of Depression on Patterns of Care, Adherence, and Patient Satisfaction among HIV-Infected Men. Paper presented at: VA HSR&D National Meeting; 2003 Feb 14; Washington, DC.
  19. Uphold CR, Jia H, Reid KJ, Bradham DD, Findley K, Bender JM, Bender BS, Duncan PW. Differences in Processes and Outcomes of HIV-related Healthcare between Patients Attending VA and Non-VA Infectious Disease Clinics. Paper presented at: VA HSR&D National Meeting; 2003 Feb 13; Washington, DC.
  20. Uphold CR, Bradshaw P, Bender BS. Biopsychosocial Predictors of HIV Symptoms. Paper presented at: Association of Nurses in AIDS Care Annual Meeting; 2002 Nov 1; San Francisco, CA.
  21. Uphold CR, Bender BS, Findley F, Graham MV, Garzarella L, Bradshaw P. Determinants and barriers to achieving healthy lifestyles in vulnerable subgroups of HIV-infected males. Paper presented at: State of Science Advancing Nursing Practice Excellence Annual Congress; 2002 Sep 26; Washington, DC.


DRA: Health Systems
DRE: Diagnosis, Treatment - Observational
Keywords: Nursing, Patient outcomes, Rural
MeSH Terms: Outcome Assessment (Health Care), HIV

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