Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

should I start HIV antiviral drugs?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

indications for beginning treatment. Benefits and cost of new medication regimens among patients who have CD4 counts over 500.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

HIV patients, who comprise 1.2 million Americans. They are mostly men, men who have sex with mean, and are mostly under 50.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

There are differences in the metabolism of some drugs, but there is some evidence about efficacy of treatment regimens among different groups,

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

improvement in exploring reasons for either deciding to begin treatment or delaying treatment that is based on evidence.

Describe any health-related risks, side effects, or harms that you are concerned about.

some patients have misperceptions about the treatment side effects that are based on old drugs. Others have not thought about medication because they are unaware of the increased morbidity of not starting medications. A synthesis of the evidence would provide a great benefit to providers and clients.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Infectious diseases, including HIV/AIDS
• Substance abuse

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

only 25% of patients with HIV infection have viral control. Despite programs that make the medications available, we are not doing a good job of convincing patients that being on medications is imperative in maintaining their quality of life.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Thru my work in public policy committees, public health groups and as a board member of a community based organization, I have realized that dissemination of good data is needed in order for us to develop more effective media campaigns, combat the stigma associated with the disease, and decrease the silence that has overtaken the epidemic in the US.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There is decreasing benefit to starting antiretrovirals earlier in the disease for the patient, but there are public health calls to treat everyone to treat treatment options as a prevention tool to stop the spread of the epidemic. There is certainly controversy about the rights/ responsibilities and health benefits/risk to the individual vs society as a whole

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will distill information from international and national studies, to the level of providers who are interacting with patients groups, or to the one-to-one interaction between a provider and his or her patient.

Describe the timeframe in which an answer to your question is needed.

Before next world aids day in Dec 2013, but it is more important to have the data

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

hiv infection is now affecting more disanfranchised communinities in the US, especially in the South and in urban areas.

Individuals affected by HIV suffer from higher rates of mental illness, substance abuse, poverty, lack of access to medical care. They are disproportionally impacted by other illnesses including Hep C, hep B, some cancers, and cardiovascular disease,

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It will distill information from international and national studies, to the level of providers who are interacting with patients groups, or to the one-to-one interaction between a provider and his or her patient.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

searching the web