▪ Abstract Our ability, as leaders in public health scholarship and practice, to achieve and measure progress in addressing racial/ethnic disparities in health status and health care is severely constrained by low levels of participation of racial/ethnic minority populations in health-related research. Confining our review to those minority groups federally defined as underrepresented (African Americans/blacks, Latinos/Hispanics, and Native Americans/American Indians), we identified 95 studies published between January 1999 and April 2005 describing methods of increasing minority enrollment and retention in research studies, more than three times the average annual output of scholarly work in this area during the prior 15-year period. Ten themes emerged from the 75 studies that were primarily descriptive. The remaining 20 studies, which directly analyzed the efficacy or effectiveness of recruitment/retention strategies, were examined in detail and provided useful insights related to four of the ten factor...

https://www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.27.021405.102113

Effective recruitment and retention of minority research participants

Competing events can preclude the event of interest from occurring in epidemiologic data and can be analyzed by using extensions of survival analysis methods. In this paper, the authors outline 3 regression approaches for estimating 2 key quantities in competing risks analysis: the cause-specific relative hazard ((cs)RH) and the subdistribution relative hazard ((sd)RH). They compare and contrast the structure of the risk sets and the interpretation of parameters obtained with these methods. They also demonstrate the use of these methods with data from the Women's Interagency HIV Study established in 1993, treating time to initiation of highly active antiretroviral therapy or to clinical disease progression as competing events. In our example, women with an injection drug use history were less likely than those without a history of injection drug use to initiate therapy prior to progression to acquired immunodeficiency syndrome or death by both measures of association ((cs)RH = 0.67, 95% confidence interval: 0.57, 0.80 and (sd)RH = 0.60, 95% confidence interval: 0.50, 0.71). Moreover, the relative hazards for disease progression prior to treatment were elevated ((cs)RH = 1.71, 95% confidence interval: 1.37, 2.13 and (sd)RH = 2.01, 95% confidence interval: 1.62, 2.51). Methods for competing risks should be used by epidemiologists, with the choice of method guided by the scientific question.

Competing Risk Regression Models for Epidemiologic Data

The Women's Interagency HIV Study (WIHS) is an ongoing long-term observational study of 3,772 women who are either infected with human immunodeficiency virus (HIV) or considered to be at risk for acquiring HIV. Since 1994, the WIHS (pronounced like “wise”) has developed a large database and specimen repository that serve as resources for WIHS investigators as well as for nonaffiliated researchers working on HIV-related or HIV coinfection issues. The purpose of this report is to update researchers on the progress of the WIHS and to provide information on WIHS resources, the methods by which they were obtained, and background for any new potential researchers interested in conducting collaborative research through shared use of these resources.

https://cvi.asm.org/content/cdli/12/9/1013.full.pdf

The Women's Interagency HIV Study: an observational cohort brings clinical sciences to the bench.

BackgroundRelatively high plasma levels of soluble urokinase-type plasminogen activator receptor (suPAR) have been associated with focal segmental glomerulosclerosis and poor clinical outcomes in patients with various conditions. It is unknown whether elevated suPAR levels in patients with normal kidney function are associated with future decline in the estimated glomerular filtration rate (eGFR) and with incident chronic kidney disease. MethodsWe measured plasma suPAR levels in 3683 persons enrolled in the Emory Cardiovascular Biobank (mean age, 63 years; 65% men; median suPAR level, 3040 pg per milliliter) and determined renal function at enrollment and at subsequent visits in 2292 persons. The relationship between suPAR levels and the eGFR at baseline, the change in the eGFR over time, and the development of chronic kidney disease (eGFR <60 ml per minute per 1.73 m2 of body-surface area) were analyzed with the use of linear mixed models and Cox regression after adjustment for demographic and clinical v...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1506362

Soluble Urokinase Receptor and Chronic Kidney Disease

Recent studies among HIV-infected populations have linked use of combination antiretroviral therapy with increased risk of cardiovascular disease (CVD) events [1-4] and subclinical atherosclerosis [5-7]. Among HIV-infected individuals, low CD4+ T-cell count has also been identified as a vascular risk factor [5]. However, the data have not been consistent as other studies have not confirmed the reported associations of antiretroviral use [8-11] or low CD4+ T-cell count [2] with clinical or subclinical CVD.

Several potential mechanisms have been described that may link HIV disease and its treatment with increased risk of vascular disease. Individuals with untreated HIV infection have decreased levels of high-density lipoprotein cholesterol (HDL-C) and increased levels of triglycerides [12-14], which are adverse risk factors for vascular disease. On the other hand, persons with untreated HIV infection also have reductions in low-density lipoprotein cholesterol (LDL-C) and total cholesterol, which may be favorable characteristics with regard to atherosclerotic risk [12-14]. Initiation of antiretroviral therapy tends to normalize lipid parameters (total cholesterol, LDL-C and triglycerides, but not HDL-C) [14]. Some therapies, notably protease inhibitors (PI), may have adverse effects on LDL-C and triglyceride levels, blood pressure, and risk of diabetes [15-19]. Use of nucleoside analogs has been associated with body fat changes, insulin resistance and diabetes [20-22]. Circulating markers of inflammation such as C-reactive protein (CRP) may be elevated among individuals with HIV infection, especially during progression to AIDS [23].

The purpose of the present investigation was to assess the association of HIV infection, HIV disease parameters (including CD4+ T-cell counts, HIV viral load, and AIDS) and antiretroviral medication use with subclinical vascular disease. We report the results from two studies, conducted in parallel, within the Women's Interagency HIV Study (WIHS) and the Multicenter AIDS Cohort Study (MACS). WIHS and MACS are population-based US cohort studies that offer several important strengths, including large sample size, inclusion of HIV-uninfected persons who were recruited from the same at-risk populations as the HIV-infected individuals, and extensive longitudinal, protocol-driven data collection on clinical, behavioral, and demographic variables. The present report describes data from the baseline phase of a WIHS-MACS Carotid Ultrasound Substudy, which features standardized image acquisition and measurement of carotid artery intima-media thickness, a quantitative measure of atherosclerosis burden.

/pdf/low-cd4-t-cell-count-as-a-major-atherosclerosis-risk-factor-94jr2wx0gj.pdf

Low CD4+ T cell count as a major atherosclerosis risk factor in HIV-infected women and men

Even though women and people of color represent an increasing proportion of US acquired immunodeficiency syndrome (AIDS) cases, few research studies include adequate representation of these populations. Here the authors describe recruitment and retention of a diverse group of human immunodeficiency virus (HIV)-infected and at risk HIV-uninfected women in a prospective study operating in six sites across the United States. Methods used to minimize loss to follow-up in this cohort are also described. For the first 10 study visits that occurred during a 5-year period between 1994 and 1999, the retention rate of participants was approximately 82%. In adjusted Cox analysis, factors associated with retention among all women were older age, African-American race, stable housing, HIV-infected serostatus, past experience in studies of HIV/AIDS, and site of enrollment. In an adjusted Cox analysis of HIV-infected women, African-American race, past experience in studies of HIV/AIDS, site of enrollment, and reported use of combination or highly active antiretroviral HIV therapy at the last visit were significantly associated with retention. In adjusted Cox analysis of HIV-uninfected study participants, only the site of enrollment was significantly associated with study retention. These results show that women with and at risk for HIV infection, especially African-American women, can be successfully recruited and retained in prospective studies.

Retention of Women Enrolled in a Prospective Study of Human Immunodeficiency Virus Infection: Impact of Race, Unstable Housing, and Use of Human Immunodeficiency Virus Therapy

Yvonne Barranday

Papers

The Women's Interagency HIV Study: an observational cohort brings clinical sciences to the bench.

Retention of Women Enrolled in a Prospective Study of Human Immunodeficiency Virus Infection: Impact of Race, Unstable Housing, and Use of Human Immunodeficiency Virus Therapy