Category: Health and Health Care
Objective: Advances in HIV treatment make it possible for people living with HIV (PLWH) to require nursing homes (NHs) care for age-related illnesses rather than advanced HIV disease. This population has not been studied since 2000, when they were on average 44 years old, majority African American (59.3%), and suffered from high rates of dementia (21%) and pneumonia (13.6%).
Methods: A nationwide sample of Medicare eligible PLWH was identified and summarized from a 2011-2013 dataset of the Centers for Medicare and Medicaid Services’ Medicare claims linked to the Minimum Data Set (MDS 3.0) and an all-payers prescription dispensing database. Descriptive statistics were calculated for socio-demographics, physical and mental health profiles as well as prescriptions dispensed.
Results: We identified 7056 PLWH, of which 93% had Medicaid coverage. Almost 3/4ths were male and the mean age was 60 (SD 12.17). The majority were African American (52%). The MDS Brief Interview for Mental Health status found 67% were cognitively intact and dementia has declined (8.6%). More than 50% were fully continent for bowel and bladder, 13.1% were admitted for end stage renal disease and the average Activities of Daily Living score was indicative of independence. Of the 84.7% on treatment, the most common was a single tablet, three drug combination (efavrienz+emtricitabine+tenofovir).
Conclusion: This is the first description of the HIV population in NHs after recent advances in HIV treatment. Understanding the aging HIV population in NHs is key to appropriate resource planning, competency of NH staff and providers and ensuring the best healthcare for PLWH in NHs.
Brianne Olivieri-Mui– Graduate Researcher, Northeastern University
Jean McGuire– Professor of Practice, Northeastern Univeristy
John Griffith– Clinical Professor, Northeastern University
Sean Cahill– Director of Health Policy Research, The Fenway Institute
Becky Briesacher– Associate Professor, Northeastern University
With a degree in biology and chemistry from the University of Vermont and nearly 10 years of experience working in clinical chemistry and genetics laboratories at premier hospitals in New York City I have a strong foundation in human pathophysiology. Transitioning to public health I achieved academic excellence as a graduate of the City University of New York Hunter college Urban Public Health master's program. In my public health career I have focused on disaster health outcomes and HIV-related health disparities research. For 3 years at the Fire Department of New York I worked as a data analyst and manager examining health outcomes of first responders to the 911 terror attacks. I also worked at the Center for Health Identity Behavior and Prevention Studies at New York University examining social supports and behavioral risk factors associated with HIV in young men who have sex with men. HIV is a topic about which I feel passionately. I have chosen to continue my graduate work focused on HIV in the Population Health PhD program at Northeastern University. My current research has focused on using administrative data from the Centers for Medicare and Medicaid Services to examine 1) the characteristics of and 2) the clinical and cultural competencies associated with appropriately caring for the aging HIV population.
Professor of Practice
I have a thirty year history in disability related health care financing and service delivery and in related public health program development and management. As the Assistant Secretary for the Executive Office of Health and Human Resources in Massachusetts, I oversaw disability related prevention, screening, intervention, program development, service delivery and health and long term care financing issues. My experience with HIV, geriatrics and the CMS system pre-dates my recent tenure and includes a prior six year period in Columbus, OH and Washington D.C. where I was an Assistant Director and then Executive Director, taking part in development of multi-site, proprietary Medicaid intermediate care facilities for people with severe mental and physical disabilities, coordinated federal health insurance, long term care, housing and tax policy for the Association for Retarded Citizens, worked as a lobbyist for a broad national disability coalition as well as AIDS Action Council and directed a nationally representative public policy association on AIDS during a period of significant federal budget and statutory regulatory development. As the Assistant Commissioner at the MA Department of Public Health I directed the HIV/STD, Hepatitis C programs, developing innovative policy, program and fiscal strategies to address changing epidemic challenges.
I have extensive experience, training, and collaborations in the planning and analysis of data from clinical and health-related studies. Before coming to Northeastern University in 2012, I spent over 20 years at Tufts Medical Center and Tufts University where I developed and directed research centers designed to provide biostatistical and data support to clinical and health researchers. I directed the Biostatistics Research Center and later the Design and Data Resource Center at the Tufts CTSI. I was also the Statistical Director for the General Clinical Research Center and for the Biostatistics Core at the Tufts Medical Center Cancer Center. As the Associate Dean for Research and co-Director of the Biostatistics Service Center (BSC) at the Bouvé College of Health Sciences at Northeastern University I continue to collaborate with researchers across the University in the development of sound research designs and analytic approaches. I have planned, supported and directed data coordination centers and the statistical analyses for numerous clinical trials and studies. I was a co-Principal Investigator for the data coordinating center for the NHLBI-funded Immediate Trial, a national randomized controlled clinical trial testing the impact of pharmacological myocardial metabolic support in the form of intravenous glucose, insulin, and potassium for patients with acute cardiac syndrome. I am currently a statistical consultant for the City of Boston and direct the data coordination centers and analytic cores for a PCORI-supported study investigating end-of-life decision making for patients on dialyses and for a NIH-funded investigation of the interplay of social determinants of health, health behaviors, stress, and genetics on coronary heart disease among a cohort of Puerto Rican participants. I also direct the statistical analyses for an NIH-supported project looking at the impact of limited literacy in the lives of people with serious mental illness. I teach both undergraduate and graduate courses for the School of Pharmacy, including a course in Experimental Design and Biometrics, and in the Population Health doctoral program in the Bouvé College. My many years of experience in clinical trials and statistical modeling will let me provide leadership and guidance for the analyses for this project.
Director of Health Policy Research
The Fenway Institute
I am the Director of Health Policy Research at the Fenway Institute, and Affiliate Associate Clinical Professor of Health Sciences at Northeastern University. I teach courses on LGBT public policy and HIV policy at several universities. I serve on the Massachusetts Special Legislative Commission on LGBT Aging, and conduct research on HIV prevention with youth, aging and HIV, the Ryan White Program and health care reform, and LGBT disparities. I was the Director of Curriculum and Policy for the National Center for Innovation in HIV Care, a HRSA-funded training/TA center from 2014-2017, and am currently and previously led policy research at the NGLTF Policy Institute from 1999-2007, as well as policy, research, and prevention efforts at GMHC from 2007-2011. While there, I organized the annual House of Latex Ball, and managed peer outreach staff from the GMHC Women’s Institute and the GMHC Institute for Gay Men’s Health. These projects prioritized prevention and retention in care for Black women and Black and Latino gay and bisexual men and other men who have sex with men (MSM) and transgender women. I oversaw implementation of the Community Promise and Many Men, Many Voices DEBIs with Black and Latino gay and bisexual men/MSM and transgender women in New York City. I served on the NYC Ryan White Planning Council, co-chairing its Policy Committee, co-led a cancer screening initiative with Memorial Sloan Kettering and 10 ASOs across New York City and act as co-PI of two National Institute of Corrections grants supporting the development of best practices for managing LGBT and intersex adults and juveniles in corrections. At NGLTF and GMHC I conducted research and policy analysis on sexual abuse of LGBT prisoners, implementation of the Prison Rape Elimination Act, and HIV and HCV in prison.
I am a health services researcher with expertise in the interrelated relationships among drug policy, prescription drug coverage, drug costs and ultimately the medication use of older adults. I have an established body of research on medication use in the nursing home setting. My research finds consistently that the quality of prescribing in nursing homes exhibits high variation that is not explainable by patient characteristics or the evidence-base. I am also an expert in using large datasets and methods suitable for minimizing bias in observational research; I have conducted multiple evaluations using risk-adjustment, counterfactual modeling, and quasi-experimental research designs. In summary, I have a demonstrated record of successful and productive research in areas of high relevance for health systems research, and my expertise and experience have prepared me to assist students in exploration of new topics of concern for nursing homes (i.e. HIV care in nursing homes).