2006-2008 Publications (password required)

VACS

The Veterans Aging Cohort Study (VACS) is a prospective, observational cohort study of HIV- positive and an age/race/site matched control group of HIV- negative veterans in care in the United States. The study's aim is to understand the role of comorbid medical and psychiatric disease in determining clinical outcomes in HIV infection. It is funded primarily by the National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health. The study has a special focus on the role of alcohol use and abuse in determining clinical outcomes.

The VACS study is built around the Veterans Health Administration (VA), the largest integrated health-care system in the United States, providing care to 3.6 million patients annually. The VA is also the largest single provider of HIV care in the nation, serving 19,000 HIV-positive veterans in 2003. The VA provides inpatient and outpatient medical care, pharmacy, mental-health services, substance-abuse treatment, long-term care, homeless care, and hospice services. The VA also has a national, fully electronic medical-record system that includes all routine clinical data, administrative data, and comprehensive follow-up data for mortality, as the VA pays some burial expenses for veterans.

The VACS study consists of two ongoing cohorts. The first, assembled from administrative data alone, is a “virtual cohort” of >40,000 HIV- positive veterans and a similar number of age/race/site matched HIV- negative controls, used to understand the overall impact of HIV and comorbid conditions on survival and health-care utilization. At the end of each fiscal year, this cohort is updated to include veterans with new diagnoses of HIV infection and matched controls receiving care in the same fiscal year.

The virtual cohort is complemented by a prospectively-consented, “living” cohort of veterans with and without HIV infection, currently in care at eight VA medical centers around the country. This in-depth cohort allows us to “get behind” gross associations with outcome, to better understand the likely complex and overlapping etiologies resulting in differences outcome and patient utilization. As in the virtual cohort, enrollment is ongoing. As new veterans present for care with HIV infection they will be offered enrollment, and an age/race/site matched control will be offered enrollment from the general-medicine clinic.

The VACS study has consented and enrolled >6,000 patients (half HIV-positive, half HIV-negative controls) in Atlanta, Baltimore, the Bronx, Houston, Los Angeles, Manhattan/Brooklyn, Pittsburgh, and Washington, D.C. In addition to having access to complete medical-record information (including pharmacy fills, laboratory data, pathology data, radiology data, and progress notes) and administrative data (including utilization and diagnostic codes), VACS draws from several additional sources of data: (1) patient and provider surveys (quality of life, symptoms, adherence, alcohol use, drug use, health habits) at the time of the visit; (2) telephone interviews providing in-depth data on alcohol use and medication adherence; and (3) banked serum, plasma, and blood pellets for future hypothesis testing.

The VACS Study welcomes proposals for analyses and sub-studies. Please see our contact page for updated study contact information.