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Objectives. We examined correlations between survival and race/ethnicity, age, and gender among persons who died from AIDS-related causes. Methods. We estimated survival among 11 022 persons at 12, 36, and 60 months after diagnosis with AIDS in 1993 through 2001 and reported through 2003 to the Chicago Department of Public Health. We estimated hazard ratios (HRs) by demographic and risk characteristics. Results. All demographic groups had higher 5-year survival rates after the introduction of highly active retroviral therapy (1996–2001) than before (1993–1995). The HR for non-Hispanic Blacks to Whites was 1.18 in 1993 to 1995 and 1.51 (P < .01) in 1996 to 2001. The HR for persons 50 years or older to those younger than 30 years was 1.63 in 1993–1995 and 2.28 (P < .01) in 1996–2001. The female-to-male HR was 0.90 in 1993–1995 and 1.20 (P < .02) in 1996–2001. Conclusions. The risk of death was higher for non-Hispanic Blacks and Hispanics than for non-Hispanic Whites. Interventions are needed to increase early access to care for disadvantaged groups.

This article explores trends and correlates of Chicago_s opiate-related overdose (OD) deaths. We manually examined data from every death certificate filed between 1999 and 2003 to identify all Chicago residents_ accidental deaths involving acute intoxication with illicit opiates, OD, or opiate poisoning. The analysis includes an examination of contextual characteristics in 77 Chicago neighborhoods. Negative binomial regression analysis permits the calculation of incidence rate ratios (

Background People who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers. Purpose A critical gap in the literature is the unheard voice of persons in rural underserved areas. The purpose of this study was to explore the perspectives of persons in rural Appalachia who seek healthcare services at free episodic health care clinics, a common alternative source of care. Methods In Fall 2017, a qualitative approach was used to discover the perceptions of 12 men and women in rural Appalachia who were seeking medical care at a Remote Area Medical Clinic. A transdisciplinary research group provided insight and assistance with thematic analysis in Spring 2018–Spring 2019. Results Five overall themes emerged capturing the essence of how rural Appalachians view the experience of seeking healthcare, which include difficulties with insurance/finances, inconsistency in care, isolation in rural areas, seeking solutions, and need to feel valued. Implications A rich description of participant experiences portrays real-life complexities for Appalachian men and women who seek healthcare. Understanding the perceptions of persons who seek healthcare and the essence of their experiences is the first step in determining future sustainable solutions for social justice.

ObjectivesPredictors of the efficacy of highly active antiretroviral therapy (HAART) have been investigated in several studies. To increase current knowledge, the study aimed to acquire comprehensive data over an extended observation time, to obtain information on possible performance differences among individual drugs, and to identify factors with influence on the initial response to a HAART regimen and the sustainability of the response. MethodsThe data were obtained from a prospective, single University Medical School HIV cohort. Clinical, laboratory, and treatment parameters for 475 patients were collected over 4.5 years. HAART efficacy was determined by analysis of variance and multivariate survival analysis. ResultsThe overall initial complete response (CR) (o500 HIV-1 RNA copies/mL) was 76.3%. Use of indinavir [odds ratio (OR) 5 2.747, P 5 0.0009] and the number of new nucleoside reverse transcriptase inhibitors (NRTIs) (OR 5 1.862, P 5 0.0017) were positively associated with CR, while initial peripheral blood HIV RNA concentration (OR 5 0.383, Po0.0001), use of saquinavir hard gel capsules (OR 5 0.531, P 5 0.0302), the number of successive HAART regimens (OR 5 0.631, Po0.0001), and the number of previously used NRTIs (OR 5 0.728, P 5 0.0081) were negatively associated with CR. Sustainability of CR was positively correlated with use of indinavir [hazard ratio of relapse (HR) 5 0.255, Po0.0001] and haemoglobin levels (HR 5 0.873, P 5 0.0124), but negatively correlated with initial HIV RNA concentration (HR 5 1.273, P 5 0.0003) and the number of previously used NRTIs (HR 5 1.587, Po0.0001). A higher number of consecutive HAART regimens was associated with a markedly reduced CR, but with only a slightly higher risk of relapse. ConclusionsThe initial response to HAART, as well as long-term efficacy, depends strongly on a few fundamental parameters that can easily be assessed in a clinical setting. There is a need for effective suppression of HIV replication over decades, and these factors should be considered early in treatment planning to identify patients with an unfavourable profile of risk factors for treatment failure.Keywords: antiretroviral therapy, HIV-1, observational cohort, response, treatment efficacy IntroductionA breakthrough in antiretroviral therapy (ART) was achieved by trials using triple drug regimens containing a protease inhibitor (PI), demonstrating clinical endpoint benefits (progression to AIDS or death) and sustained improvement of the surrogate markers CD4 lymphocyte count and virus concentration [1,2]. PI-containing triple drug regimens, the first kind of highly active antiretroviral therapy (HAART), led to an impressive reduction of HIVrelated morbidity and mortality [3], and replaced single or dual nucleoside reverse transcriptase inhibitor (NRTI) therapies. This first phase of HAART was characterized by a high proportion of patients who were pretreated with NRTIs, despite lack of data demonstrating substantial A number of recent studies focused on certain aspects and predictive ...