Clinical Study

The Association Of Adverse Childhood Experiences And Social Determinants Of Health On Hiv States And Outcomes

Posted Date: Aug 27, 2020

  • Investigator: David Karol
  • Specialties: AIDS-HIV, Psychiatry/Psychology
  • Type of Study: Observational/Survey

Background: Adverse childhood experiences (ACE) negatively affect the development of children and have been associated with poor health outcomes throughout life (1). It has been shown that certain populations, such as women with HIV, tend to also have higher numbers of social determinants of health, which are factors such as transportation and employment that affect health indirectly (2). Poverty itself is an ACE and tends to be associated with other ACEs (3). This research design abstract details how we will use the electronic medical record (EMR) to recruit research participants to obtain a robust study population for our research aims. For Aim 1, we hypothesize that having a higher ACE score will increase the odds of contracting HIV. Our Aim 2 hypothesis is that higher ACE scores and greater SDH will be associated with worse HIV outcomes. Methods: We developed a survey for distribution to patients presenting for appointments in both the HIV clinic and primary care clinics at the University of Cincinnati. However, due to the onset of the COVID-19 pandemic, we shifted our goal to recruit our participants entirely through the EMR. With the assistance of our EMR (Epic) technicians, we will be able to recruit up to 10,400 subjects at a time. An IRB-approved partial HIPAA waiver will allow us to identify subjects with and without HIV. This allows us to focus our efforts to obtain at least 128 participants with HIV (and 64 non-HIV subjects) to achieve at least 80% power. Interested subjects will select a link, which will lead to the survey to be completed using a RedCAP database. The survey will include the subject’s name and date of birth in order to link survey responses to the dependent variables of interest, namely HIV status and HIV outcomes (when applicable), including HIV viral load, CD4 count, and appointment attendance. Logistic regression will be used to estimate the association between demographic factors, ACE scores, and HIV status as well as to estimate rates of negative HIV outcomes as a function of demographic factors, ACEs and SDH. Discussion: Our study design highlights the use of EMR to easily recruit a large number of subjects as well as to instantly and securely store multiple independent variables. Furthermore, the ability to recruit subjects and collect data electronically through a secure database increases both ease of design and privacy of information. Similar study designs may prove helpful, particularly during the COVID-19 pandemic. Purewal boparai SK, Au V, Koita K, et al. Ameliorating the biological impacts of childhood adversity: A review of intervention programs. Child Abuse Negl. 2018;81:82-105. Shokoohi M, Bauer GR, Kaida A, et al. Social determinants of health and self-rated health status: A comparison between women with HIV and women without HIV from the general population in Canada. PLoS ONE. 2019;14(3):e0213901. Crouch E, Probst JC, Radcliff E, Bennett KJ, Mckinney SH. Prevalence of adverse childhood experiences (ACEs) among US children. Child Abuse Negl. 2019;92:209-218.




Electronic Health Record, Electronic Medical Record

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David Karol

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