Who's In and Who's Out: Use of Primary Medical Care Among People Living With HIV

The authors of the current study sought a more comprehensive picture of access to medical care for the treatment of HIV (HIV primary care). They achieved this by combining evidence of medical services used (health utilization) and epidemiological client-level data.

Health information from several data sources was integrated to measure utilization of HIV primary care in the St. Louis, Mo., area from 1998 to 2002. The researchers combined data from disparate HIV health utilization databases with data from the Missouri HIV and AIDS Reporting System database. Data were then de-identified to measure client-level utilization of HIV primary care over time.

Around half of those with HIV showed evidence of having initiated HIV primary care in a given year. While most of this group utilized care in the first year after receiving their HIV diagnosis, evidence of subsequent utilization was inconsistent. Primary care utilization was most strongly associated with an AIDS diagnosis. About one-quarter of people diagnosed with HIV after 1997 received an AIDS diagnosis at the same time they tested positive for HIV.

"This study was the first of its kind to integrate several databases to understand HIV primary health care utilization over a period of years. Our findings reinforce the importance of CD4 and viral load values as indicators of utilization of HIV primary health care, particularly in the absence of other health data sets," the researchers concluded, noting the study was limited by the lack of available data and the way in which source data were available.

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