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Vulnerable HIV Patients Less Likely To Have Care (Reuters Health)
October 24, 2006 (Reuters Health)—Members of minority groups, who are most at risk of contracting HIV infection and most likely to be in greatest need of service, are also the individuals who are least likely to be receiving medical care in the U.S., investigators report.
The majority of population-based studies regarding health services utilization among HIV-infected individuals have concentrated on those who are receiving medical care, simply because they are the most convenient groups to study, note Dr. William E. Cunningham, from the UCLA School of Public Health in Los Angeles, and colleagues.
To assess HIV care in underserved populations, the research team studied "grass-roots" outreach programs designed to engage "hard-to-reach" HIV-infected populations with medical care. Individuals interviewed as part of the Targeted HIV Outreach and Intervention Initiative (Outreach) "were overwhelmingly racial/ethnic minorities, substance users, and the poor," the investigators report in their article, to be published in the November issue of Medical Care.
The Outreach sample consisted of 1286 HIV-positive persons recruited from 16 Ryan White Care Act-funded study sites and interviewed in 2001-2002. Venues included client neighborhoods, churches, public clinics, bars, mobile vans, homeless shelters, single resident hotels, jails and parks.
Dr. Cunningham and his colleagues compared the characteristics of subjects in the Outreach sample with 2267 subjects in the HIV Costs and Services Utilization Study (HCSUS), a nationally representative population of HIV-positive patients recruited from HIV provider practices and interviewed in 1998.
In the Outreach group, a significantly smaller proportion of subjects were white than in the HCSUS group (18.4% versus 49.3%). They were more likely to have an annual income < $10,000 (75.4% versus 44.6%), had been homeless within the last 6 months (34.1% versus 6.8%), and were more likely to be receiving mental health care (45.9% versus 26.7%).
Clinically, those in the Outreach sample were less likely to being treated with antiretroviral drugs when indicated and most likely to have fewer than two ambulatory visits in the previous 6 months.
Many of the large differences between the two cohorts suggest that a different approach may be required to improve the care of the underserved, Dr. Cunningham and his team maintain.
For example, they suggest, "recent heavy alcohol use was strongly associated with lower ambulatory care utilization in the Outreach sample but not in HCSUS, which suggests that providing alcohol treatment services may be particularly beneficial in increasing ambulatory medicare use among persons reached through outreach efforts."
