More Than Ancillary: HIV Social Services, Intermediate Outcomes and Quality of Life

In the context of HIV care, social or "ancillary" services to stabilize life situations and remove barriers to care are "often seen as a means to the end of ensuring more consistent participation in medical care," the authors wrote. They examined the impact of HIV social services on the achievement of intermediate outcomes (i.e., stopping substance use, starting antiretroviral therapy [ART], and securing stable housing) and the relationship between quality of life (QOL) and intermediate outcome status. Their analysis seeks to demonstrate the value of achieving such intermediate outcomes "in and of themselves" and thus the importance of the ancillary services that help clients attain desired intermediate outcomes.

The current study uses data (baseline and follow-up) from 1,646 persons with HIV; the data were collected during a longitudinal outcome evaluation of 23 HIV social service programs in the New York City metro area. Multivariate linear regression modeling was used to determine the impact of achieving intermediate outcomes on QOL at follow-up, controlling for baseline QOL, and demographic factors.

The results showed the greatest QOL improvements were in persons who changed their intermediate outcome status from using drugs to not using drugs; from not using ART to using ART; and from being in an unstable housing situation to being in a stable one.

"Our analysis strongly suggests the importance of achieving intermediate outcomes in improving QOL, and thereby the importance of social services that facilitate the achievement of these intermediate outcomes," the authors wrote. "Our study suggests that social services are not merely ancillary in HIV care but rather crucial for achieving both intermediate outcomes as well as the final outcome of improved QOL." In addition, the analysis offers further validation of a QOL measure by demonstrating that it varies in systematic and expected ways with the achievement of intermediate outcomes.

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