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CHAIN
The CHAIN Study

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The Community Health Advisory & Information Network (CHAIN) Project, is an ongoing prospective study of a representative samples of persons living with HIV/AIDS in New York City and the Tri-County region of Westchester, Rockland and Putnam Counties. CHAIN is conducted by researchers from Mailman School of Public Health at Columbia University as part of the evaluation activities of New York City's Health and Human Services Planning Council. Its purpose is to supply systematic data from the perspective of persons living with HIV about their needs for health and human services, their encounters with the full continuum of HIV services, and their physical, mental and social well being.

During 1994 and 1995, a two-stage sampling method was used to recruit a cohort that would be representative of HIV-positive adults (age 20+ years) who were aware of their positive HIV serostatus. For the first stage, 50 recruitment sites were randomly selected from a sampling frame of 341 medical and social service agencies known to serve an adult clientele and to have HIV case loads of 20 or more. For the second stage, a sample of HIV positive clients were recruited from 43 of the sites either through random selection from a client list prepared by agency staff, or through onsite, sequential enrollment. To complete the CHAIN longitudinal cohort, HIV-positive individuals unconnected to medical care and case management services at the time of the interview were also recruited to supplement the agency-based sampling strategy. These "unconnected" individuals were contacted at outreach sites and through acquaintance sampling from among enrolled CHAIN participants. Baseline interviews were completed with 648 HIV+ individuals from the agency sites and 52 HIV+ individuals unconnected to services. Cohort attrition has remained low. Among CHAIN participants alive and still living in NYC, survey completion rates were in excess of 80 % and exceeded 90 percent for 4 of the 7 follow-up rounds of interviews. Individuals lost to follow-up over the course of study showed few differences when compared with those who continued to participate.

In 2002, at the direction of the Planning Council, Columbia researchers recruited an entirely new cohort of 693 HIV+ adults residents of New York City, following the same methodology used for the original CHAIN cohort. The CHAIN "new cohort" study began enrolling clients in July, 2002 and closed enrollment in December, 2003. A total of 684 HIV positives in care, and 9 persons living with HIV unconnected to care were recruited and interviewed. The two rounds of follow-up interviews have completed by 2006.

In addition to the New York City cohort studies, the CHAIN program of research was extended to three northern suburban counties, Putnam, Rockland, and Westchester counties. Using the same methodology of sampling, Tri-County CHAIN recruited a cohort of 398 adults in the 2001 and 84 refresher cohorts during 2005 and 2006, and four rounds of interviews have completed by 2006. The same core measures are being used which allow cross-cohort as well as cross time comparisons. A fifth round of Tri-County interviews is to commence during the fall of 2007.

CHAIN interviews, take approximately two hours to complete, and are conducted in person by trained community interviewers who were matched to respondents as much as possible with regard to gender and race/ethnicity. Approximately 10% of interviews are conducted in Spanish. Several members of the field staff are themselves HIV positive. Major interview topic areas include: (1) need for health and social services, (2) access, utilization and satisfaction with health and social services, (3) sociodemographic characteristics, (4) housing and other aspects of living situation; (5) sex and drug risk behaviors; (6) informal caregiving from friends, family and volunteers, and (7) their quality of life with respect to health status and psychological and social functioning. A number of items have been added over the years related to antiretroviral therapies, specific medical care services, viral load levels, and other topics of interest to policymakers, planners, providers, and clients on the CARE Act Title A Planning Council. Follow-up interviews are conducted at annual intervals.

Each year CHAIN researchers produce a series of reports for the New York HIV Planning Council responding to the questions, interests, and priorities of the Council and its workgroups, the NYC Department of Health and Mental Hygiene (DOHMH) Office of AIDS Policy Coordination, and provider and consumer communities.. To date, over 100 reports have been written examining a range of topics with focus on unmet health and social service needs, trends in service utilization, and various outcomes among the CHAIN cohort. All CHAIN reports are available at no cost and widely distributed.

A Technical Review Team (TRT) provides oversight for the CHAIN Project in New York City and in the Tri-County. In addition to Peter Messeri, PhD and Angela Aidala, PhD of Columbia University's Mailman School of Public Health, TRT is consists of representatives from Medical and Health Research Association (MHRA), NYC DOHMH, Westchester County Department of Health, and New York City Office of AIDS Policy.

The CHAIN program of research has been made possible by grants from the US Health Resources and Services Administration (HRSA) HIV/AIDS Bureau. The CHAIN study is supported by the HIV Health and Human Services Planning Council of New York under a Title A grant of the Ryan White CARE through the New York City Department of Health and Mental Hygiene. CHAIN is conducted under the auspices of the Medical and Health Research Association of New York City, Inc, and the Westchester County Department of Health. In addition to the work done on behalf of the Planning Council, CHAIN researchers have conducted special studies funded by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau and the Centers for Disease Control and Prevention.

Below is a complete list of CHAIN documents since the study's inception in 1994. Not all of the studies are available electronically. The studies that are available are underlined and link to a pdf* version of the document.

For more information about Columbia University's Center for Applied Public Health, which produces the CHAIN reports, click here. In additional to more information about the Center and its mission, there are CHAIN reports in pdf format.

TECHNICAL REPORTS
Tech #1 8/31/94 SAMPLE DESIGN FOR STAFFING NEEDS AND CLIENT SURVEY STUDIES
Tech #2 7/5/94 SURVEY OF PERSONNEL NEEDS OF HIV/AIDS AGENCIES: RECRUITMENT & RETENTION DIFFICULTIES AND PERSONNEL INCENTIVE PROGRAMS
Tech #3 9/27/95 TRAINING FOR HIV/AIDS SERVICE AGENCIES
Tech #4 3/1/95 SUMMARY TABLES FOR CLIENT SURVEY - THE FIRST 100 CASES
Tech #5 8/2/95 A TRI-COUNTY SURVEY OF THE PERSONNEL NEEDS OF HIV/AIDS SERVICE AGENCIES
Tech #6 8/2/95 THE PERSONNEL NEEDS STUDY PART II: DELIVERY
Tech #7R 12/14/95 SUMMARY TABLES FOR BASELINE CLIENT SURVEY
Tech #8 10/20/95 THE ADOLESCENT HIV STUDY: NEEDS, UTILIZATION AND BARRIERS FOR MEDICAL CARE, SOCIAL SERVICES AND PREVENTION EDUCATION
Tech #9 11/17/95 THE "UNCONNECTED" - SERVICE NEEDS OF HIV POSITIVE PERSONS WHO ARE OUTSIDE OR MARGINAL TO THE SERVICE DELIVERY SYSTEM
Tech #10 5/10/96 HOUSING & HIV/AIDS IN NEW YORK CITY
Tech #11 5/12/96 HIV CASE MANAGEMENT SERVICES IN NYC: QUALITY AND OUTCOMES
Tech #12 5/22/96 SUBSTANCE USE & HIV AIDS IN NEW YORK CITY
Tech #13 6/3/96 THE INFRASTRUCTURE WORK GROUP REPORT
Tech #14 6/10/96 HIV HEALTH CARE SERVICES IN NEW YORK CITY: UTILIZATION AND QUALITY
Tech #15 (136Kb) 6/16/96 ACCESSING MEDICAL AND SOCIAL SERVICES: BARRIERS AND STRATEGIES FOR IMPROVING HIV CARE INFRASTRUCTURE
Tech #16 6/18/96 NEED FOR MENTAL HEALTH SERVICES AND SERVICE UTILIZATION IN NEW YORK CITY
Tech #17 10/4/96 SUMMARY TABLES TIME 2 CLIENT SURVEY
Tech #18 04/24/00 CLIENT OUTCOMES RAPID RESPONSE REPORTS
 
RAPID RESPONSE REPORTS
Rap Resp#2 4/21/97 ECONOMIC SECURITY & INCOME CHARACTERISTICS OF THE BASELINE SAMPLE
Rap Resp#3 4/14/00 HIGH RISK BEHAVIORS: UNPROTECTED SEX & NEEDLE
 
BRIEFING PAPER
Briefing Paper#1 04/29/99 THE UNCONNECTED REVISITED: A CHAIN BRIEFING PAPER UPDATE REPORTS
 
UPDATE REPORTS
Update Rep#1 04/21/97 THE INTRODUCTION OF COMBINATION THERAPIES
Update Rep#2 04/21/97 MIGRATION TO SERVICES
Update Rep#3 04/28/97 FAMILY CONSTELLATIONS AND NEED FOR SOCIAL SERVICES
Update Rep#4 04/24/97 MANAGED CARE AND HEALTH SERVICES FOR PEOPLE LIVING WITH HIV
Update Rep#5 05/30/97 CONTINUITY AND CHANGE IN HOUSING PROBLEMS & NEED FOR HOUSING SERVICES
Update Rep#6 05/09/97 ACCESS TO PRIMARY AND CHANGE IN HEALTH PROBLEMS & NEED FOR HOUSING SERVICES
Update Rep#7 05/30/97 MATCHING CLIENT NEEDS AND INTENSITY OF CASE MANAGEMENT: A METHODOLOGY FOR PLANNING AND EVALUATION
Update Rep#8 06/17/97 SUBSTANCE USE AND NEED FOR ALCOHOL & DRUG SERVICES
Update Rep#9 12/97 NEED FOR MENTAL HEALTH SERVICES AND SERVICE UTILIZATION
Update Rep#11 03/4/98 UNDERSTANDING MIGRATION TO SERVICES
Update Rep#12 04/15/98 TRENDS IN USE OF HIV ANTIRETROVIRAL THERAPY
Update Rep#13 04/24/98 SATISFACTION AND DISSATISFACTION WITH MEDICAL AND SOCIAL SERVICES
Update Rep#14 04/27/98 INDIVIDUAL INITIATION AND CESSATION OF ANTIRETOVIRAL THERAPY
Update Rep#15 02/18/98 TRENDS IN MANAGED CARE PLANS AND PEOPLE LIVING WITH HIV
Update Rep#16 05/1/98 TOP CLIENT IDENTIFIED UNMET NEEDS FOR MEDICAL AN SOCIAL SERVICES
Update Rep#18 04/12/99 COHORT COMPARISON: ASSESSING CHANGES & TRENDS BETWEEN THE 1994 AND1998 CHAIN COHORTS
Update Rep#19 05/03/99 TRENDS IN CURRENT USE OF HIV ANTIRETROVIRAL THERAPY-1998
Update Rep#20 05/19/99 PATTERNS OF ADHERENCE TO ANTIRETROVIRAL MEDICATION
Update Rep#21 05/12/99 TRENDS IN HEALTH STATUS
Update Rep#22 05/18/99 NEEDS ASSESSMENT FOR WORK-RELATED SERVICES AMONG PERSONS LIVING WITH HIV/AIDS
Update Rep#23 05/1/00 PATTERNS OF ADHERENCE TO ANTIRETROVIRAL MEDICATIONS, 1995-1999
Update Rep#24 (239Kb) 04/27/00 COMORBID CONDITIONS: INTERSECTING NEEDS AMONG THE CHAIN COHORT
Update Rep#25 04/27/00 FACTORS INFLUENCING INTEREST IN EMPLOYMENT AMONG PERSONS LIVING WITH HIV
Update Rep#26 04/28/00 DECLINING MORTALITY RATES AND SERVICE INTERVENTIONS
Update Rep#27 04/27/00 COMPLEMENTARY AND ALTERNATIVE MEDICINE: RATES OF UTILIZATION AMONG THE CHAIN COHORT
Update Rep#28 04/21/00 WOMEN'S NEED FOR AND UTILIZATION OF SERVICES BY FAMILY TYPES
Update Rep#29 06/2000 MENTAL HEALTH SERVICES & TREATMENT NEEDS
Update Rep#30 (258Kb) 04/12/00 THE IMPACT OF ANCILLARY SERVICES ON ENTRY & RETENTION TO HIV MEDICAL CARE IN NEW YORK CITY
Update Rep#32 (386Kb) 04/17/00 HOUSING ASSISTANCE AND HOUSING STABILITY AMONG PERSONS LIVING WITH HIV/ AIDS
Update Rep#33 03/28/01 DENTAL SERVICES FOR HIV+INDIVIDUALS IN NYC'S CHAIN COHORT
Update Rep#34 (184Kb) 08/16/01 MEDICATION ADHERENCE AND PATIENT OUTCOMES
Update Rep#35 (194Kb) 05/23/01 ASSESSING THE IMPACT OF RYAN WHITE CARE ACTON ON HEALTH OUTCOMES N NYC: EXECUTIVE SUMMARY
Update Rep#35a (228Kb) 05/23/01 RYAN WHITE IMPACT TECHNICAL TABLES
Update Rep#36 (171Kb) 07/25/01 PATHWAYS TO MEDICAL CARE
Update Rep#37 (206Kb) 07/25/01 HOUSING AND MEDICAL CARE AMONG PERSONS LIVING WITH AIDS
Update Rep#38 (175Kb) 07/31/01 ANCILLARY SERVICES AND ADHERENCE
Update Rep#39 (507Kb) 07/24/01 TRENDS IN HEALTH STATUS, UPDATED
Update Rep#40 (397Kb) 12/01 PATHWAYS TO MENTAL HEALTH SERVICES
Update Rep#41 (253Kb) 11/13/01 HOUSING STATUS AND HEALTH OUTCOMES AMONG PERSONS LIVING WITH HIV/AIDS
Update Rep#42 (2.11Mb) 12/12/01 GEOGRAPHIC DISPLAY OF THE CHAIN COHORT AND SERVICE UTILIZATION
Update Rep#43 (258Kb) 12/19/02 LOW THRESHOLD AOD PROGRAMS
Update Rep#44 (416Kb) 12/19/02 LATINOS IN THE CHAIN COHORT
Update Rep#45 (323Kb) 02/19/03 PATTERNS OF SEXUAL BEHAVIORS AND SEXUAL RISK AMONG HIV POSITIVE PEOPLE IN NEW YORK CITY
Update Rep#46 (146Kb) 07/25/02 CHRONIC DISEASES AND CLINICAL COMORBIDITIES
Update Rep#47 (400Kb) 01/15/03 CHAIN RETROSPECTIVE: 1994-2002

Retrospective: Unmet Need (50.6Kb)

 
BRIEF COMMUNICATIONS
2002-1 (345Kb) 07/24/02 TRAUMA & VIOLENCE
2002-2 (129Kb) 04/16/02 DRUG HOLIDAYS
2002-3 (292Kb) 08/10/02 FOOD & NUTRITION
2002-4 (254Kb) 04/16/03 RELIGION AND SPRIRTUALITY AMONG PERSONS LIVING WITH HIV
 
MEMOS
2002-1 (345Kb) 07/25/02 PATTERNS OF MEDICAL CARE AND SUBSTANCE USE PROVIDERS
2002-2 (84.8Kb) 07/25/02 PARTNER NOTIFICATION
2002-3 (191Kb) 07/25/02 MEDICAL CARE VISITS
2002-4 (118Kb) 11/20/02 PEOPLE OVER 50 YEARS OLD WITH HIV/AIDS
2005-1 (58.4Kb) 02/18/05 Briefing Memo on HIV Treatment Using CHAIN Data
2005-2 (112Kb) 04/19/05 Utilization of Case Management by CHAIN Respondents
 
TRI-COUNTY REPORTS
2002-1 11/13/02 COHORT CHARACTERISTICS
2002-2 11/13/02 HEALTH STATUS & HEALTH SERVICE UTILIZATION
2002-3 11/13/02 STIGMA & SOCIAL ISOLATION
2002-4 11/13/02 FIELD NOTES
2002-5 11/13/02 SUPPORT GROUPS
2002-6 11/13/02 BASELINE NEEDS ASSESSMENT
11/12/03 (1.70Mb) 11/12/03 Analyzing Needs & Service Gaps Using the Tri-County CHAIN Study
01/09/04 (26.0Kb) 01/09/04 Proposed Tri-County CHAIN Reports: 2003-2004
03/24/05 (155Kb) 03/24/05 Tri-County CHAIN Presentation - Service Gaps & Key Health Measures
11/01/07 (77Kb) 11/01/07 Tri-County CHAIN Report 2007 - 1 Housing, Transportation, and HIV Medical Care and Outcomes
11/20/07 (82Kb) 11/20/07 Tri-County CHAIN Report 2007 - 2 Components of Medical Care
11/10/07 (77Kb) 11/07/07 Tri-County CHAIN Report 2007 - 3 Service Needs & Gaps
 
REPORTS
1999 (223Kb)   The Unconnected Revisited: A CHAIN Briefing Paper
2001-10 (84Kb)   Housing Status and Health Outcomes among Persons Living with HIV-AIDS
2001-11 (2.1Mb)   Geographic Display of The CHAIN Cohort and Service Utilization
2002-1 (348kb)   Exposure to Trauma and Violence among Persons Living with HIV
2002-1a (288kb)   Drug Use and Service Utilization Among People with HIV in New York City- Barriers to Care and Low Threshold Services
2002-1b (172kb)   TC_The Tri-County Cohort- Demographics & Other Characteristics
2002-2 (132kb)   HIV Drug Holidays Among the CHAIN Cohort
2002-2a (440kb)   Latino Populations in The CHAIN Cohort
2002-2b (164kb)   TC_Health Status and Health Service Utilization
2002-3 (296kb)   Utilization of Food and Nutrition Services among People With HIV in NYC
2002-3a (140kb)   Patterns of Sexual Behaviors and Sexual Risk among HIV Positive People in New York City
2002-3b (156kb)   TC_Stigma & Social Isolation
2002-4 (256kb)   Religion And Spirituality Among Persons Living with HIV
2002-4a (64kb)   Chronic Diseases and Clinical Comorbidities
2002-4b (136kb)   TC_ Field Notes; Recruiting a Longitudinal Cohort
2002-5 (348kb)   Patterns of Medical Providers and Substance Use Providers
2002-5a (148kb)   The CHAIN Retrospective 1994-2002
2002-5b (144kb)   TC_Support Groups
2002-6 (88kb)   Partner Notification
2002-6 (136kb)   TC_Baseline Needs Assessment of the Tri-County Cohort
2002-7 (192kb)   Trends in Medical Care Visits
2002-7 (104kb)   TC_Key Findings from Final 2002 TC CHAIN Data Reports
2002-8 (120kb)   People Over 50 Years Old with HIV-AIDS
2003-1 (275Kb)   2003-1 Strategic Plan Progress Indicators: Baseline Report
2003-1a (404kb)   Strategic Plan Progress Indicators; Baseline Project
2003-1b (328kb)   TC_Service Gaps and Utilization in the Continuum of Care
2003-2a (748Kb)   Geographical Distribution of Service Gaps Among the NYC CHAIN Cohort; A Geomapping Analysis
2003-2b (92Kb)   TC_Do Treatment Adherence Programs Lead to Better Client Outcomes.pdf
2003-3a (60Kb)   Validation of Self-Reported Viral Load Levels
2003-3b (1.4Mb)   Tri-County Report 2003_3 A Geographic Display of Health & Social Service Agencies in the Tri-County Region
2003-4a (120Kb)   Client Attributes and Service Intervention Correlates of Self Reported Viral Load Levels
2003-4b (104Kb)   Partner Notification
2003-5a (204Kb)   Delayed Entry to HIV Care
2003-5b (124Kb)   Estimating the Number of HIV-AIDS Infected Individuals in the Tri-County Region, in Care and Not in Care
2003-6 (176Kb)   Housing Assessment Summary
2003-7 (444Kb)   Strategic Plan Progress Indicators; New Cohort Update
2004-1 (948Kb)   Factors Associated with Delayed Care Seeking Among HIV-Infected Individuals in New York City
2004-1 (268Kb)   Services Gaps and Utilization in the Continuum of Care in New York City
2004-1a (28Kb)   Haitian Respondents in TC CHAIN Cohort
2004-2 (632Kb)   Permanency Planning & Case Mgmnt Memo
2004-2 (80Kb)   STRATEGIC PLAN PROGRESS INDICATORS: NEW COHORT UPDDATE
2004-3 (264Kb)   Baseline Summary of NYC II Cohort
2004-3 (160Kb)   Service Gaps & Strategic Plan Progress Indicators Summary Findings
2004-4 (204Kb)   Field Notes: Recruiting CHAIN's 2002 Longitudinal NYC Cohort
2004-5 (232Kb)   Comprehensive Care Models
2004-6 (356Kb)   The Validity of Self-Reported Clinical Markers and Medication Regimens: A Pilot Study
2004-7 (52Kb)   Regional Variation in the Use of Highly Active Antiretroviral Therapy
2005-1 (60Kb)   Briefing Memo on HIV Treatment
2005-1a (92Kb)   Prevention for Positives
2005-1b (276Kb)   HIV Medication Regimens & Treatment Success- PI-based vs PI-sparing, in 3 Cohorts
2005-2 (110Kb)   Delayers, Drop-outs, the Unconnected, and "Unmet need"
2005-2 (116Kb)   Utilization of Case Management
2005-2a (168Kb)   Delayers, Drop-Outs, The Unconnected and Unmet Needs.
2005-2b (228Kb)   Trends in HAART & Treatment Adherence
2005-3 (82Kb)   Service Gaps and Service Utilization in NYC
2005-3a (80Kb)   Service Gaps and Service Utilization in New York City; Wave 2 Update
2005-3b (228Kb)   Prevention for Positives
2005-4 (51.4Kb)   HIV Medication Regimens and Treatment Success
2005-4a (48Kb)   HIV Medication Regimens & Treatment Success- PI-Based Vs. PI-Sparing in 3 Cohorts
2005-4b (216Kb)   TC_Population Profile- Socioeconomic and Health Characteristics of Men who have Sex with Men (MSM), Non-MSM Men, and Women
2005-5 (208Kb)   Service Gaps Update- A 3 Wave Analysis
2005-6 (36Kb)   Key Findings From 2003-2005 TC CHAIN Data Reports
2006-1 (156Kb)   Service Gaps Among Special Populations of HIV+ Adults in New York City
2006-1a (144Kb)   Gender Differences in Neighborhood Service Use
2006-1b (44Kb)   Prevalence of Interpersonal Violence within the Tri-County CHAIN Cohort
2006-2 (80Kb) 07/13/06 Medical Services Utilization
2006-3 (124Kb)   HIV/AIDS And Aging
2006-4 (88Kb)   Housing and Entry Into Medical Care
2006-5 (529Kb)   Housing Need, Housing Assistance and Connection to Medical Care
2006-6 (84Kb)   Employment & Economic Wellbeing
2006-7 (60Kb) 12/20/06 Interpersonal Violence and Negative Health Behaviors
2007-1 (352Kb)   Changes in the CHAIN Study Questionnaire W3 vs W4
2007-1a (100Kb)   Need for Mental Health Srvs, Srvc Use, and Pathways
2007-1b (80Kb)   Housing, Transportation, and HIV Medical Care and Outcomes
2007-2a (112Kb)   Satisfaction and Dissatisfaction with Medical Services and Primary Medical Provider
2007-2b (548Kb)   Satisfaction and Dissatisfaction with Case Management and Social Services
2007-2c (84Kb)   Components of Medical Care
2007-3 (139Kb)   Pathways to Systems of HIV Medical Care final
2007-3a (88Kb)   Pathways to Systems of HIV Medical Care
2007-3b (80Kb)   Service Needs Gaps Wave 4 Update in Tri-County
2007-4 (144Kb)   Prevalence of Chronic Diseases Comorbid Conditions PLWHA
2008-1 (92Kb)   Need For Mental Health Services, Service Use, and Pathways to Care
2008-1a (236Kb)   Service Needs and Utilization New York City Round 5 Interviews: 2008-2009
2008-2 (180Kb)   Predictors of Antiretroviral Treatment Effectiveness
2009-1 (188Kb)   Demographics of Food Program Users
2009-2 (128Kb)   First 100 Cases for TC 2008 2009 Cohort
2009-3 (288Kb)   Changes in Survey W5 vs W6
2009 (220Kb) 12-14-09 INDEX of CHAIN Reports
2011 (281Kb)   CHAIN Brief Report 2011 Insurance Coverage
2011-5 (143Kb)   Food and Nutrition Service Needs
2011-4 (123Kb)   CHAIN Brief Report 2011 -4 determinants of HAART adherence(2)_DOHMH final
 

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