Advisory Committee Chair
Advisory Committee Members
Date of Award
Degree Name by School
Doctor of Public Health (DrPH) School of Public Health
People living with HIV (PLWH) have experienced substantial increases in life expectancy, largely attributable to improvements in care such as antiretroviral therapy. As a result, there has been a concurrent increase in the development of aging-related comorbidities such as end-stage organ disease. One such comorbidity is kidney disease. Concerningly, PLWH are at disproportionately higher risk of chronic kidney disease and end-stage kidney disease (ESKD) as compared to HIV-negative counterparts. Kidney transplantation is the ideal therapy for ESKD as it is both cost-effective and provides a significant survival benefit and yet, despite excellent transplant outcomes among PLWH, access to transplantation among waitlisted PLWH remains lower than HIV-negative counterparts. Disparities in kidney transplantation typically manifest even earlier in the transplant process, often evolving at referral for transplant or waitlist addition. Unfortunately, HIV-status at time of ESKD diagnosis or waitlist addition is not captured in national registries, hindering efforts to examine disparities at these critical junctures on a national level. Thus, the goal of this dissertation is to leverage the existing national database of ESKD patients with accompanying Medicare claims data to identify PLWH and examine their access to the kidney transplant waitlist. Herein I examine the rate of kidney waitlist addition among PLWH as compared to HIV-negative ESKD patients, assess for potential interaction between HIV-status and patient characteristics, iv specifically race, ethnicity, sex, and geography, and examine the disparity between PLWH and HIV-negative ESKD patients using decomposition analysis.
Shelton, Brittany A., "Access to the Kidney Transplant Waitlist for People Living with HIV" (2022). All ETDs from UAB. 317.