Yale Shares in $11 Million Grant to Study Aging Patients Battling HIV and Substance Abuse

Aging HIV patients who also battle substance abuse and depression will benefit from a five-year $11,250,000 grant from the National Institute on Alcohol Abuse and Alcoholism to The Consortium to improve OutcoMes in hiv/AIDS, Alcohol, Aging, and multi-Substance use (COMpAAAS), a Yale-led research consortium focused on optimizing healthcare for these patients.

The consortium includes the Veterans Administration Healthcare System, Yale’s Schools of Medicine and Public Health, and New York University. It builds on a decade of observational and pilot intervention work conducted within the Veterans Aging Cohort Study (VACS) of over 120,000 United States veterans, which includes 40,000 individuals living with HIV. COMpAAAS will expand alcohol intervention studies using a stepped care approach. Its aim is to understand the implications of findings and to determine what additional evidence is needed.

Amy Justice, M.D., professor of medicine and public health at Yale, is principal investigator of the center and of the VACS, which examines the independent effects of alcohol use and abuse, aging, HIV infection, and HIV treatment, as well as the interaction between these factors. With these funds, VACS will be continued and extended for another five years.

“We are entering a new era in HIV care, in which more people are living with HIV than ever before,” said Justice, who also serves as section chief of general internal medicine in the Veterans Administration Connecticut Healthcare System, and is affiliated with Yale’s Center for Interdisciplinary Research on AIDS. “Because they already suffer from chronic infection and toxicity from treatment, those living with HIV are likely to experience greater illness and death due to substance abuse than similar uninfected individuals.” 

David Fiellin, M.D., professor of medicine, investigative medicine and public health at Yale School of Medicine, and Scott Braithwaite, M.D., associate professor of medicine at New York University, are the principal investigators of the intervention and operations research grants. Fiellin’s grant supports a multisite randomized trial focusing on decreasing health consequences of unhealthy alcohol use in HIV infected individuals using an integrated stepped care approach. The team measures alcohol consumption, alcohol injury and the progression of HIV.

Braithwaite’s project will use mathematical models to compare data from COMpAAAS observational and intervention work with other research evidence to determine the cost-effectiveness of a portfolio of potential health interventions. The results of these research projects will likely determine individualized care for those with HIV infection.

“If we are to optimize health outcomes in this complex chronic disease, we must learn to tailor care to the individual patient by addressing behaviors and conditions that pose the greatest individual risk,” Justice said. “The various components of COMpAAAS will provide us with an ideal platform to examine the interplay of biology, behavior, and health care systems to improve patient outcomes.”

Kendall Bryant, the NIAAA scientific collaborator on the grant, said, “This is a step forward in aging research, and represents the integration of alcohol and HIV research advances in prevention and treatment. This ongoing research is part of a larger effort by NIH to strategically test new interventions that acknowledge the important role of continued alcohol use in patient outcomes.”

— By Karen N. Peart