Health Service Utilization for People With HIV Infection: Comparison of a Population Targeted for Outreach With the U.S. Population in Care
May 4, 2007
"Many persons with HIV infection do not receive consistent ambulatory medical care and are excluded from studies of patients in medical care. However, these hard-to-reach groups are important to study because they may be in greatest need of services," explained the authors of this study.
The sociodemographic, clinical, and health care utilization characteristics in two samples of HIV-positive persons were compared: patients who were hard to reach, and a nationally representative cohort of persons who were receiving care from known HIV providers in the United States. The researchers then examined whether the independent correlates of low ambulatory utilization differed between the two samples.
A sample of 1,286 persons from 16 US sites interviewed in 2001-2002 for the Targeted HIV Outreach and Intervention Initiative (Outreach) -- a study of underserved persons targeted for supportive outreach services -- was compared to 2,267 persons from the HIV Costs and Services Utilization Study (HCSUS), a probability sample of persons receiving care who were interviewed in 1998. Logistic regression analyses were used to identify differences between the two in sociodemographic and clinical associations with ambulatory medical visits.
Compared with the HCSUS sample, the Outreach sample had considerably larger proportions of black respondents (59 percent vs. 32 percent, P=0.0001), Hispanics (20 percent vs. 16 percent), Spanish-speakers (9 percent vs. 2 percent, P=0.02), those with low socioeconomic status (annual income<$10,000 75 percent vs. 45 percent, P=0.0001), the unemployed, homeless persons, no insurance, and heroin or cocaine use (58 percent vs. 47 percent, P=0.05). Those in the Outreach sample were more likely to have fewer than two ambulatory visits (26 percent vs. 16 percent, P=0.0001), more likely to have emergency room visits or hospitalizations in the previous six months, and less likely to be on antiretroviral treatment (82 percent vs. 58 percent, P=0.0001).
After stratifying for level of ambulatory utilization (fewer than two vs. two or more in the last six months), almost all these differences persisted. "In multivariate analysis, several variables showed significantly different associations in the 2 samples (interacted) with low ambulatory care utilization. The variables with significant interactions (P values for interaction shown below) had very different adjusted odds ratios (and 95 percent confidence intervals) for low ambulatory care utilization: age greater than 50 (Outreach 0.55 [0.35-0.88], HCSUS 1.17 [0.65-2.11], P=0.05), Hispanic ethnicity (Outreach 0.81 [0.39-1.69], HCSUS 2.34 [1.56-3.52], P=0.02), low income (Outreach 0.73 [0.56-0.96], HCSUS 1.35 [1.04-1.75], P=0.002), and heavy alcohol use (Outreach 1.74 [1.23-2.45, HCSUS 1.00 [0.73-1.37], P=0.02)." Elevated odds of low ambulatory medical visits in the Outreach sample were associated with having CD4 count less than 50 (1.53 [1.00-2.36], P=0.05).
The Outreach sample had far greater proportions of traditionally vulnerable groups, and were less apt to be in care if they had low CD4 counts, compared with HCSUS, the researchers determined. "Furthermore, heavy alcohol use was only associated with low ambulatory utilization in Outreach. Generalizing from in care populations may not be warranted, while addressing heavy alcohol use may be effective at improving utilization of care for hard-to-reach HIV-positive populations," they concluded.
11.2006; Vol. 44; No. 11: P. 1038-1047
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.