Variations in the Care of HIV-Infected Adults in the United States

摘要: ContextStudies of selected populations suggest that not all persons infected with human immunodeficiency virus (HIV) receive adequate care.ObjectiveTo examine variations in the care received by a national sample representative adult US population HIV.DesignCohort study consisted 3 interviews from January 1996 to January 1998 conducted HIV Cost and Services Utilization Consortium.Patients SettingMultistage probability sample 2864 respondents (68% those targeted for sampling), who represent the 231,400 persons at least 18 years old, known infection receiving medical 48 contiguous United States early 1996 in facilities other than emergency departments, military, or prisons. The first follow-up 2466 respondents the second had 2267 (65% all surviving sampled subjects).Main Outcome MeasuresService utilization (<2 ambulatory visits, at 1 department visit did lead to hospitalization, hospitalization) medication utilization (receipt antiretroviral therapy prophylaxis against Pneumocystis carinii pneumonia).ResultsInadequate was commonly reported time of interviews 1996 1997 but declined to varying degrees late 1997. Twenty-three percent patients initially 15% patients subsequently department visits hospitalization, 30% initially 26% subsequently CD4 cell counts below 0.20,×109/L receive P carinii pneumonia prophylaxis, 41% 15% subsequently below 0.50×109/L antiretroviral therapy (protease inhibitor or nonnucleoside reverse transcriptase inhibitor). Inferior patterns were seen many these measures blacks Latinos compared whites, uninsured and Medicaid-insured privately insured, women compared with men, risk and/or exposure groups men who had sex even after count adjustment. With multivariate adjustment, differences remained statistically significant. Even 1998, fewer blacks, women, started taking medication (CD4 adjusted P values <.001 <.005).ConclusionsAccess improved but remained suboptimal. Blacks, Latinos, uninsured, less desirable care. Strategies to ensure optimal requires identifying the causes deficiency addressing these important shortcomings in care.