CHAIN
The CHAIN Study
Click here to view Chain Reports
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) |
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| 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 |
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| 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 |
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| 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 |
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| REPORTS |
| 1999 (223Kb) |
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The Unconnected Revisited: A CHAIN Briefing Paper |
| 2003-1 (275Kb) |
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2003-1 Strategic Plan Progress Indicators: Baseline Report |
| 2003-2 (746Kb) |
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GEOGRAPHICAL DISTRIBUTION OF SERVICE GAPS AMONG THE NYC CHAIN COHORT: A GEOMAPPING ANALYSIS |
| 2003-3 (117Kb) |
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VALIDATION OF SELF-REPORTED VIRAL LOAD LEVELS |
| 2003-4 (116Kb) |
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Client Attributes and Service Intervention Correlation of Self Reported Viral Loads |
| 2004-1 (266Kb) |
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Services Gaps and Utilization in the Continuum of Care in New York City |
| 2004-2 (629Kb) |
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STRATEGIC PLAN PROGRESS INDICATORS: NEW COHORT UPDDATE |
| 2004-3 (261Kb) |
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Baseline Summary of NYC II Cohort |
| 2004-4 (202Kb) |
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Field Notes: Recruiting CHAIN's 2002 Longitudinal NYC Cohort |
| 2004-5 (231Kb) |
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Comprehensive Care Models |
| 2004-6 (353Kb) |
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The Validity of Self-Reported Clinical Markers and Medication Regimens: A Pilot Study |
| 2005-1 (88.3Kb) |
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Prevention for Positives |
| 2005-2 (110Kb) |
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Delayers, Drop-outs, the Unconnected, and "Unmet need" |
| 2005-3 (82Kb) |
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Service Gaps and Service Utilization in NYC |
| 2005-4 (51.4Kb) |
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HIV Medication Regimens and Treatment Success |
| 2006-1 (245Kb) |
05/31/06 |
Gender Differences in Neighborhood Service Use |
| 2006-2 (234Kb) |
07/13/06 |
Medical Services Utilization |
| 2006-3 (309Kb) |
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HIV/AIDS And Aging |
| 2006-4 (86.7Kb) |
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Housing and Entry Into Medical Care |
| 2006-5 (449Kb) |
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Housing Need, Housing Assistance and Connection to Medical Care |
| 2006-6 (205Kb) |
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Employment & Economic Wellbeing |
| 2006-7 (188Kb) |
12/20/06 |
Interpersonal Violence and Negative Health Behaviors |
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