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Laws MB, Epstein L, Lee Y, Rogers W, Beach MC, Wilson IB. The association of visit length and measures of patient-centered communication in HIV care: a mixed methods study. PATIENT EDUCATION AND COUNSELING 2011; 85:e183-e188. [PMID: 21592716 PMCID: PMC3158953 DOI: 10.1016/j.pec.2011.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 03/08/2011] [Accepted: 04/08/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Patient centered clinical communication may be associated with longer encounters. METHODS We used the General Medical Interaction Analysis System (GMIAS) to code transcripts of routine outpatient visits in HIV care, and create 5 measures of patient-centeredness. We defined visit length as number of utterances. To better understand properties of encounters reflected in these measures, we conducted a qualitative analysis of the 15 longest and 15 shortest visits. RESULTS All 5 measures were significantly associated with visit length (p<0.05, rank order correlations 0.21-0.44). In multivariate regressions, association of patient centeredness with visit length was attenuated for 4 measures, and increased for 1; two were no longer statistically significant (p>0.05). Black and Hispanic race were associated with shorter visits compared with White race. Some of the longest visits featured content that could be considered extraneous to appropriate care. CONCLUSION Patient centeredness is weakly related to visit length, but may reflect inefficient use of time in long encounters. PRACTICE IMPLICATIONS Efforts to make visits more patient centered should focus on improving dialogue quality and efficient use of time, not on making visits longer. Shorter visits for Black and Hispanic patients could contribute to health disparities related to race and ethnicity.
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Beach MC, Saha S, Korthuis PT, Sharp V, Cohn J, Wilson IB, Eggly S, Cooper LA, Roter D, Sankar A, Moore R. Patient-provider communication differs for black compared to white HIV-infected patients. AIDS Behav 2011; 15:805-11. [PMID: 20066486 PMCID: PMC2944011 DOI: 10.1007/s10461-009-9664-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Poor patient-provider interactions may play a role in explaining racial disparities in the quality and outcomes of HIV care in the United States. We analyzed 354 patient-provider encounters coded with the Roter Interaction Analysis System across four HIV care sites in the United States to explore possible racial differences in patient-provider communication. Providers were more verbally dominant in conversations with black as compared to white patients. This was largely due to black patients' talking less than white patients. There was no association between race and other measures of communication. Black and white patients rated their providers' communication similarly. Efforts to more effectively engage patients in the medical dialogue may lead to improved patient-provider relationships, self-management, and outcomes among black people living with HIV/AIDS.
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Affiliation(s)
- Mary Catherine Beach
- Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD, USA.
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Belperio PS, Mole LA, Boothroyd DB, Backus LI. Trends in uptake of recently approved antiretrovirals within a national healthcare system. HIV Med 2009; 11:209-15. [PMID: 19863620 DOI: 10.1111/j.1468-1293.2009.00764.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to describe Veterans Healthcare Administration (VHA) system-wide uptake of three HIV protease inhibitors: atazanavir, darunavir and tipranavir. METHODS This retrospective cohort study evaluated VHA uptake of three target antiretrovirals and lopinavir/ritonavir in each complete 90-day quarter since approval to December 2007 using VHA HIV Clinical Case Registry data. We assessed uptake using number of new prescriptions, number of providers and facilities prescribing target agents, provider type, clinic type, facility size and location within four US regions. RESULTS Overall, 6551 HIV-infected veterans received target antiretrovirals. Uptake was generally greatest within the first year after Food and Drug Administration (FDA) approval, and then slightly declined and plateaued. Geographically, early adoption of new antiretroviral drugs tended to occur in the Western USA, as evidenced by comparison of uptake patterns of new antiretrovirals to use of all antiretroviral agents. A small percentage of prescribers of all antiretrovirals were responsible for new prescriptions for target medications, particularly for darunavir and tipranavir. Providers at almost 50% of VHA facilities were prescribing these agents within the first year. CONCLUSIONS Uptake of new antiretrovirals in the VHA generally reflected overall prescribing of all antiretrovirals, suggesting a lack of VHA impediments to new antiretrovirals in the healthcare system. Some regional variation in uptake among the targeted antiretrovirals occurred over time but tended to resolve after the first several months. Providers responsible for early prescribing of the target medications were limited to a fraction of providers who tended to be physicians who practised in infectious disease (ID) clinics at medium-sized facilities.
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Affiliation(s)
- P S Belperio
- Department of Veterans Affairs, Center for Quality Management in Public Health, Palo Alto, CA, USA.
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Moody AL, Morgello S, Gerits P, Byrd D. Vulnerabilities and caregiving in an ethnically diverse HIV-infected population. AIDS Behav 2009; 13:337-47. [PMID: 17876698 PMCID: PMC3815540 DOI: 10.1007/s10461-007-9310-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 08/17/2007] [Indexed: 10/22/2022]
Abstract
The current study aimed to identify the primary informal caregivers of a group of urban HIV+ adults (n = 250) and to determine relationships between demographic, medical, and substance use characteristics and caregivers types. Reported caregiver types included 36.8% familial, 22.4% significant other, and 22.8% institutional or other caregiver relationships. The remaining 18% of the sample reported having no individual that rendered informal care. Factors associated with the absence of an informal caregiver included African American race and low education. Hispanic participants reported the highest frequency of family caregivers while participants with a history of substance disorder were less likely to identify a significant other as a caregiver. This study demonstrates the evolving nature of informal caregiving in HIV, race- and education-related disparities in the absence of primary caregivers, and the importance of sociocultural and demographic factors in the study of HIV caregiving.
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Affiliation(s)
- Anissa L. Moody
- Department of Pathology, Mt Sinai School of Medicine, New York, NY, USA; Manhattan HIV Brain Bank, Mt. Sinai School of Medicine, One Gustave Levy Place, Box 1134, New York, NY 10029, USA
| | - Susan Morgello
- Department of Pathology, Mt Sinai School of Medicine, New York, NY, USA; Manhattan HIV Brain Bank, Mt. Sinai School of Medicine, One Gustave Levy Place, Box 1134, New York, NY 10029, USA
| | - Pieter Gerits
- Department of Pathology, Mt Sinai School of Medicine, New York, NY, USA; Manhattan HIV Brain Bank, Mt. Sinai School of Medicine, One Gustave Levy Place, Box 1134, New York, NY 10029, USA
| | - Desiree Byrd
- Department of Pathology, Mt Sinai School of Medicine, New York, NY, USA; Manhattan HIV Brain Bank, Mt. Sinai School of Medicine, One Gustave Levy Place, Box 1134, New York, NY 10029, USA
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Côté J, Godin G, Garcia PR, Gagnon M, Rouleau G. Program development for enhancing adherence to antiretroviral therapy among persons living with HIV. AIDS Patient Care STDS 2008; 22:965-75. [PMID: 19072103 DOI: 10.1089/apc.2008.0124] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this paper the development of a self-management program to optimize long-term adherence to antiretroviral therapy for people living with HIV/AIDS is presented. The program is based on intervention mapping: that is, a framework that facilitates the use of theory and empirical evidence in intervention development. In the preparatory phase we conducted a needs-assessment. The results of this phase were then used in the operational phase in which the program was elaborated as follow: in Step 1 we established program objectives; in Step 2 we translated theoretical methods into practical strategies; and in Step 3 we integrated the strategies into a self-management program which were designed to help individuals mobilize their skills to cope with their antiretroviral therapies (ART). These particular abilities are: ability to integrate ART in daily routine, to cope with side effects, to handle situations in which ART is difficult to take, to interact with health professionals and to maintain relationships with social contacts. To address individuals' resources and skills in conjunction with the experience of taking the medication, we developed two different modalities to deliver the intervention: direct support and virtual support. Direct support consists of four 45-minute individualized, face-to-face sessions with a health professional. The Web application involved at least four interactive sessions with a computer. This application was developed with the intention to support individuals in managing their therapy, in a punctual, real-time mode. Treatment adherence behavior is an indicator or gauge that can reveal problems in being able to manage the therapy.
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Affiliation(s)
- José Côté
- Research Chair in Innovative Nursing Practices, University of Montreal, CRCHUM, Montréal, Quebec, Canada
| | - Gaston Godin
- Canada Research Chair on Behavior and Health, Laval University, Quebec City, Quebec, Canada
| | - Pilar Ramirez Garcia
- Research Chair in Innovative Nursing Practices, University of Montreal, CRCHUM, Montréal, Quebec, Canada
| | - Marilou Gagnon
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Genevieve Rouleau
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Gebo KA, Fleishman JA, Reilly ED, Moore RD. High rates of primary Mycobacterium avium complex and Pneumocystis jiroveci prophylaxis in the United States. Med Care 2005; 43:III23-30. [PMID: 16116306 DOI: 10.1097/01.mlr.0000175631.34438.1e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND National data from the mid-1990s demonstrated that many eligible patients with HIV infection do not receive prophylaxis for opportunistic infections (OIs) and that racial and gender disparities existed in OI prophylaxis receipt. OBJECTIVE We examined whether demographic disparities in use of OI prophylaxis persist in 2001 and if outpatient care is associated with OI prophylaxis utilization. RESEARCH DESIGN Demographic, clinical, and pharmacy utilization data were collected from 10 U.S. HIV primary care sites in the HIV Research Network. SUBJECTS This study consisted of adult patients (>or=18 years old) in longitudinal HIV primary care. MEASURES Indications for Pneumocystis jiroveci pneumonia (PCP) or Mycobacterium avium complex (MAC) prophylaxis were 2 or more CD4 counts less than 200 or 50 cells/mm(3) during calendar year (CY) 2001, respectively. Using multivariate logistic regression, we examined demographic and clinical characteristics associated with receipt of PCP or MAC prophylaxis and the association of outpatient utilization with appropriate OI prophylaxis. RESULTS Among eligible patients, 88.1% received PCP prophylaxis and 87.6% received MAC prophylaxis. Approximately 80% had 4 or more outpatient visits during CY 2001. Adjusting for care site, male gender (odds ratio [OR], 1.47), Medicare coverage (OR, 1.60), and having 4 or more outpatient visits in a year (OR, 2.34) were significantly associated with increased likelihood of PCP prophylaxis. Adjusting for care site, having 4 or more outpatient visits in a year (OR, 1.85) was associated with increased likelihood of receipt of MAC prophylaxis. There were no demographic or insurance characteristics associated with receipt of MAC prophylaxis. CONCLUSIONS The overall prevalence of OI prophylaxis has increased since the mid-1990s, and previous racial and HIV risk factor disparities in receipt of OI prophylaxis have waned. Integration into the healthcare system is an important correlate of receiving OI prophylaxis.
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Affiliation(s)
- Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Marcus M, Maida CA, Freed JR, Younai F, Coulter ID, Der-Martirosian C, Liu H, Freed B, Guzmán-Becerra N, Shapiro M. Oral white patches in a national sample of medical HIV patients in the era of HAART. Community Dent Oral Epidemiol 2005; 33:99-106. [PMID: 15725172 DOI: 10.1111/j.1600-0528.2004.00171.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Several types of HIV-related oral mucosal conditions have been reported to occur during the course of HIV disease progression. Of these, few may be manifested as 'white' lesions and many are noticeable to the patient. This paper examines the relationships between social, behavioral and medical aspects of HIV infection and reporting an occurrence of oral white patches (OWP) by HIV-infected patients. METHODS The subjects are participants in all three interviews in the HIV Cost and Services Utilization Study (HCSUS). The subjects were selected using a three-stage probability sampling design. The multivariate analysis is based on 2109 subjects with nonmissing binary outcome variable for all three waves representing a national sample of 214 000 individuals. The multivariate model was fitted using generalized estimating equations (GEE) by implementing the XTGEE command in STATA. RESULTS We estimate that 75 000 persons (35%) reported at least one incident of OWP, of these 14 000 reported having OWP during all three interviews, and that the rate of reporting declined over the three HCSUS waves. The multivariate analysis showed seven variables that were significant predictors of at least one report of OWP. CONCLUSIONS Compared with persons on HAART therapy, patients on other regimens or taking no antiviral medications were 23-46% more likely to report an incident of OWP. Compared with whites, African Americans were 32% less likely to report OWP, while current smokers were 62% more likely than nonsmokers. Being diagnosed with AIDS and having CD4 counts less than 500 significantly increased the likelihood of reporting OWP.
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Affiliation(s)
- Marvin Marcus
- Division of Public Health and Community Dentistry, UCLA School of Dentistry, International Center for Dental Health Policy, Los Angeles, CA 90095-1668, USA.
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Rusch M, Nixon S, Schilder A, Braitstein P, Chan K, Hogg RS. Use of antiretroviral therapy among HIV positive individuals living in British Columbia. AIDS Care 2005; 16:914-22. [PMID: 15385247 DOI: 10.1080/09540120412331290176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to examine the level of antiretroviral use and characterize individuals accessing antiretroviral therapy in British Columbia. The study was conducted by the British Columbia Persons with AIDS Society and the British Columbia Centre for Excellence in HIV/AIDS. Self-administered questionnaires were mailed out to HIV-positive members from May to September of 2002. Comparisons of sociodemographic characteristics and disease status were made using Pearson's Chi2 and the Kruskal-Wallis test for continuous variables. A total of 764 (51%) HIV-positive participants returned the questionnaire. Of these, 80% reported ever using antiretroviral therapy and 64.5% indicated current use. Reasons for never taking antiretroviral therapy were high CD4 or doctor's advice (74/126; 59%), feeling healthy (50/126; 40%) and being afraid of side-effects (35/126; 28%). Those reporting current antiretroviral use were more likely to be older (p<0.001), white (p=0.01), male (p<0.001), gay or bisexual (p<0.001), graduated from high school (p=0.001), non-injecting drug user (IDU) (p<0.001) and earning a household income greater than CAN$10,000/year (p=0.003). IDU status and length of time since diagnosis remained significantly associated with antiretroviral use in multivariate models. The differences in current antiretroviral use by sociodemographic characteristics such as IDU suggest that the need remains to target marginalized populations in order to maximize the health benefits from antiretroviral therapy.
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Affiliation(s)
- M Rusch
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, University of British Columbia, Vancouver, Canada.
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Gebo KA, Fleishman JA, Conviser R, Reilly ED, Korthuis PT, Moore RD, Hellinger J, Keiser P, Rubin HR, Crane L, Hellinger FJ, Mathews WC. Racial and Gender Disparities in Receipt of Highly Active Antiretroviral Therapy Persist in a Multistate Sample of HIV Patients in 2001. J Acquir Immune Defic Syndr 2005; 38:96-103. [PMID: 15608532 DOI: 10.1097/00126334-200501010-00017] [Citation(s) in RCA: 221] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND National data from the mid-1990s demonstrated that many eligible patients did not receive highly active antiretroviral therapy (HAART) and that racial and gender disparities existed in HAART receipt. We examined whether demographic disparities in the use of HAART persist in 2001 and if outpatient care is associated with HAART utilization. METHODS Demographic, clinical, and pharmacy utilization data were collected from 10 US HIV primary care sites in the HIV Research Network (HIVRN). Using multivariate logistic regression, we examined demographic and clinical differences associated with receipt of HAART and the association of outpatient utilization with HAART. RESULTS In our cohort in 2001, 84% of patients received HAART and 66% had 4 or more outpatient visits during calendar year (CY) 2001. Of those with 2 or more CD4 counts below 350 cells/mm in 2001, 91% received HAART; 82% of those with 1 CD4 test result below 350 cells/mm received HAART; and 77% of those with no CD4 counts below 350 cells/mm received HAART. Adjusting for care site in multivariate analyses, age >40 years (adjusted odds ratio [AOR] = 1.13), male gender (AOR = 1.23), Medicaid coverage (AOR = 1.16), Medicare coverage (AOR = 1.73), having 1 or more CD4 counts less than 350 cells/mm (AOR = 1.33), and having 4 or more outpatient visits in a year (OR = 1.34) were significantly associated with an increased likelihood of HAART. African Americans (odds ratio [OR] = 0.84) and those with an injection drug use risk factor (OR = 0.86) were less likely to receive HAART. CONCLUSIONS Although the overall prevalence of HAART has increased since the mid-1990s, demographic disparities in HAART receipt persist. Our results support attempts to increase access to care and frequency of outpatient visits for underutilizing groups as well as increased efforts to reduce persistent disparities in women, African Americans, and injection drug users (IDUs).
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Affiliation(s)
- Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Dobalian A, Andersen RM, Stein JA, Hays RD, Cunningham WE, Marcus M. The impact of HIV on oral health and subsequent use of dental services. J Public Health Dent 2003; 63:78-85. [PMID: 12816137 DOI: 10.1111/j.1752-7325.2003.tb03479.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study examined differences in health and access to dental services among a nationally representative sample of patients with HIV using Andersen's Behavioral Model of Health Services Use. METHODS This investigation is a longitudinal study that used structural equation modeling to analyze data from the HIV Cost and Services Utilization Study, a probability sample of 2,864 adults under treatment for HIV infection. Key predisposing variables included sex, drug use, race/ethnicity, education, and age. Enabling factors included income, insurance, and regular source of care. Need factors included mental, physical, and oral health. Dependent variables included whether a respondent utilized dental services and number of visits. RESULTS More education, dental insurance, usual source of dental care, and poor oral health predicted a higher probability of having a dental visit. African Americans, Hispanics, those exposed to HIV through drug use or heterosexual contact, and those in poor physical health were less likely to have a dental visit. Of those who visited dental professionals, older persons, those with dental insurance, and those in worse oral health had more visits. African Americans and persons in poor mental health had fewer visits. CONCLUSIONS Persons with more HIV-related symptoms and a diagnosis of AIDS have a greater need for dental care than those with fewer symptoms and without AIDS, but more pressing needs for physical and mental health services limit their access to dental services. Providers should better attend to the oral health needs of persons with HIV who are in poor physical and mental health.
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Affiliation(s)
- Aram Dobalian
- Department of Health Services Administration, University of Florida, PO Box 100195, Gainesville, FL 32610-0195, USA.
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Ramírez García P, Côté JK. Factors affecting adherence to antiretroviral therapy in people living with HIV/AIDS. J Assoc Nurses AIDS Care 2003; 14:37-45. [PMID: 12953611 DOI: 10.1177/1055329003252424] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Antiretroviral treatments have given hope to people living with HIV/AIDS and play a role in improving their quality of life. However, the effectiveness of these treatments is directly related to the level of adherence and commitment to them. Researchers have demonstrated that there are many factors that play an important role in adopting and maintaining adherence behavior. In this article, the authors present an indepth review of the literature and from this, enumerate the factors that link adherence behavior to the individual, the treatment, the illness, and the relationship with the health professional. An understanding of these factors is essential to develop interventions that will improve adherence to therapeutic regimens among people with HIV/AIDS.
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Ghani AC, Donnelly CA, Anderson RM. Patterns of antiretroviral use in the United States of America: analysis of three observational databases. HIV Med 2003; 4:24-32. [PMID: 12534956 DOI: 10.1046/j.1468-1293.2003.00129.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize patterns of antiretroviral use in HIV-infected patients and explore variation by patient characteristics and disease stage. METHODS Three large patient databases recording information derived from routine clinical attendance were analyzed: HIV Insight (n = 10 873), Target Management Services (n = 2226) and Clinical Partners (n = 1505). Each database records the dates of starting and stopping individual antiretroviral agents over time, measurements of CD4 T-cell counts and HIV-RNA levels at approximately 6-monthly intervals, and the demographic characteristics of patients. The number, frequency and duration of different antiretroviral combinations over time and their relationship to stage of HIV-disease and demographic characteristics were explored. RESULTS Over 2000 different combinations of antiretroviral agents are recorded. From 1987 onwards, the use of zidovudine increased, with 23% of patients receiving monotherapy by 1990. The majority of treated patients remained on monotherapy until the introduction of highly active antiretroviral therapy (HAART) in 1996. By 1999, the standard of care was HAART, with 84% of patients beginning antiretroviral therapy with HAART. Those of African American race (odds ratio 0.59) and funded by Medicaid (odds ratio 0.72) were significantly less likely to begin antiretroviral therapy on HAART. Until 1995, there was a significant decrease in CD4 T-cell count when starting antiretroviral therapy. No significant trend was observed in either CD4 T-cell count or viral load after this time. Those starting on HAART therapies were significantly less likely to stop or switch regimens than those on nucleoside reverse transcriptase inhibitor (NRTI)-only therapies (P < 0.001). CONCLUSIONS Complex patterns of antiretroviral treatment are observed in this large population. Changes over time mirror the introduction of the new antiretroviral agents.
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Affiliation(s)
- A C Ghani
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London, UK.
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Blair JM, Fleming PL, Karon JM. Trends in AIDS incidence and survival among racial/ethnic minority men who have sex with men, United States, 1990-1999. J Acquir Immune Defic Syndr 2002; 31:339-47. [PMID: 12439211 DOI: 10.1097/00126334-200211010-00011] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We describe trends in AIDS incidence, survival, and deaths among racial/ethnic minority men who have sex with men (MSM). METHODS We examined AIDS surveillance data for men diagnosed with AIDS from 1990 through 1999, survival trends from 1993 through 1997, and trends in AIDS incidence and deaths from 1996 to 1999, when highly active antiretroviral therapy (HAART) was introduced. RESULTS The percentage of racial/ethnic minority MSM with AIDS increased from 33% of 26,930 men in 1990 to 54% of 17,162 men in 1999. From 1996 through 1998, declines in AIDS incidence were smallest among black MSM (25%, from 66.2 to 49.5 per 100,000) and Hispanic MSM (29%, from 39.3 to 27.8), compared with white MSM (41%, from 17.9 to 10.5). Declines in deaths of MSM with AIDS were also smallest among black MSM (53%, from 39.7 to 18.6 deaths per 100,000) and Hispanic MSM (61%, 21.6 to 8.4), compared with white MSM (63%, 12.3 to 4.5). Survival improved each year for all racial/ethnic groups but was poorest for black MSM in all years. CONCLUSIONS Since the introduction of HAART, a combination of factors that include relatively higher infection rates in more recent years and differences in survival following AIDS diagnosis contribute to observed differences in trends in AIDS incidence and deaths among racial/ethnic minority MSM. Increased development of culturally sensitive HIV prevention services, and improved access to testing and care early in the course of disease are needed to further reduce HIV-related morbidity in racial/ethnic minority MSM.
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Affiliation(s)
- Janet M Blair
- Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Palacio H, Kahn JG, Richards T, Morin SF. Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature. Public Health Rep 2002. [DOI: 10.1016/s0033-3549(04)50158-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Policy Statements Adopted by the Governing Council of the American Public Health Association, October 24, 2001. Am J Public Health 2002. [DOI: 10.2105/ajph.92.3.451] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cook JA, Cohen MH, Grey D, Kirstein L, Burke J, Anastos K, Palacio H, Richardson J, Wilson TE, Young M. Use of highly active antiretroviral therapy in a cohort of HIV-seropositive women. Am J Public Health 2002; 92:82-7. [PMID: 11772767 PMCID: PMC1447394 DOI: 10.2105/ajph.92.1.82] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined longitudinal trends in use of highly active antiretroviral therapy (HAART) among a cohort of HIV-positive participants in the Women' Interagency HIV Study. METHODS Beginning in 1994, 1690 HIV-positive women reported detailed information about their use of antiretroviral therapy at 6-month study visits. Multivariate logistic and Cox regression analyses were used to estimate the likelihood of antiretroviral therapy and HAART use among women with study visits preceding and following HAART availability. RESULTS Before the availability of HAART, the cohort' likelihood of any antiretroviral therapy use was associated with clinical indicators (CD4 count, viral load, symptom presence) as well as behavioral factors (abstaining from drug and alcohol use, participating in clinical trials). After HAART became commercially available, newly emerging predictors included college education, private insurance, absence of injection drug use history, and not being African American. CONCLUSIONS After the penetration of HAART into this cohort, additional differences emerged between HAART users and nonusers. These findings can inform public health efforts to enhance women' access to the most effective types of therapy.
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Affiliation(s)
- Judith A Cook
- Mental Health Services Research Program, Department of Psychiatry, University of Illinois at Chicago, 104 S Michigan Ave, Suite 900, Chicago, IL 60603, USA.
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Smith SR, Kirking DM. The effect of insurance coverage changes on drug utilization in HIV disease. J Acquir Immune Defic Syndr 2001; 28:140-9. [PMID: 11588507 DOI: 10.1097/00126334-200110010-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Insurance coverage facilitates access to life-saving medications for many patients with HIV disease. Thus, the effects of insurance coverage changes, such as the gain or loss of coverage, may be important in explaining patient access and adherence to the medications used in the treatment of HIV disease. OBJECTIVES The study's objective was to examine whether changes in health insurance coverage affect rates of prescription drug use by patients with HIV disease. METHODS Data were ascertained from adults participating in a series of up to six interviews as part of the AIDS Costs and Services Utilization Survey (ACSUS). ACSUS was an 18-month panel survey of patients in care for HIV/AIDS at 26 sites located in 10 U.S. cities. Poisson regression analyses with generalized estimating equations were conducted to determine the effects of demographic and socioeconomic variables on the acquisition rate of antiretrovirals, antipneumocystics, and antidepressants. The analytic sample consisted of 1566 respondents who provided 6518 interviews. RESULTS Although changes in insurance coverage were common, complete loss of insurance was reported in only 1.5% of the interviews whereas gaining insurance was reported in 3.3% of interviews. Having no coverage was associated with significantly lower rates of antiretroviral (rate ratio [RR], 0.73), antipneumocystic (RR, 0.58) and antidepressant use (RR, 0.31). Gaining insurance coverage was associated with lower antiretroviral (RR, 0.75) and antipneumocystic (RR, 0.70) use whereas losing insurance was associated with lower antiretroviral use (RR, 0.58). In multivariate analyses, these associations remained. CONCLUSIONS Changes in health insurance coverage are associated with lower rates of drug use for some medications used by patients with HIV disease.
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Affiliation(s)
- S R Smith
- Division of Pharmaceutical Policy and Evaluative Sciences, The University of North Carolina at Chapel Hill, 27599-7360, USA.
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Research and intervention on racism as a fundamental cause of ethnic disparities in health. Am J Public Health 2001; 91:515-6. [PMID: 11236455 PMCID: PMC1446572 DOI: 10.2105/ajph.91.3.515] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Trust fund for developing countries to meet national commitment under the WHO Framework Convention for Tabacco Control. Am J Public Health 2001; 91:520. [PMID: 11236462 PMCID: PMC1446586 DOI: 10.2105/ajph.91.3.520b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affirming the importance of regulating pesticide exposures to protect public health. Am J Public Health 2001; 91:491-2. [PMID: 11236431 PMCID: PMC1446590 DOI: 10.2105/ajph.91.3.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Restoration of nutrition and health benefits eligibility to documented immigrants. Am J Public Health 2001; 91:517-8. [PMID: 11236457 PMCID: PMC1446578 DOI: 10.2105/ajph.91.3.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Condemnation of pharmaceutical manufacturers' retaliatory tactics. Am J Public Health 2001; 91:521. [PMID: 11236464 PMCID: PMC1446591 DOI: 10.2105/ajph.91.3.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maximizing public health protection with integrated vector control. Am J Public Health 2001; 91:497-8. [PMID: 11236436 PMCID: PMC1446568 DOI: 10.2105/ajph.91.3.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Public health role of the National Fire Protection Association in setting codes and standards for the built environment. Am J Public Health 2001; 91:503-4. [PMID: 11236442 PMCID: PMC1446617 DOI: 10.2105/ajph.91.3.503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Discontinuation of the use of the island-municipality of Vieques, P.R., for the US Navy's training exercises. Am J Public Health 2001; 91:514-5. [PMID: 11236454 PMCID: PMC1446607 DOI: 10.2105/ajph.91.3.514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Protecting OSHA's jurisdiction over home workplaces. Am J Public Health 2001; 91:498-9. [PMID: 11236437 PMCID: PMC1446610 DOI: 10.2105/ajph.91.3.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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International trade policy and issues of improving access to drugs for HIV/AIDS and other life-threatening and disabling diseases. Am J Public Health 2001; 91:505. [PMID: 11236444 PMCID: PMC1446623 DOI: 10.2105/ajph.91.3.505b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Joint resolution in support of National Public Health Performance Standards Program. Am J Public Health 2001; 91:505-6. [PMID: 11236445 PMCID: PMC1446588 DOI: 10.2105/ajph.91.3.505a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Eliminating access barriers in public health meetings. Am J Public Health 2001; 91:507-8. [PMID: 11236447 PMCID: PMC1446593 DOI: 10.2105/ajph.91.3.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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International multilateral and bilateral debt relief. Am J Public Health 2001; 91:508. [PMID: 11236448 PMCID: PMC1446558 DOI: 10.2105/ajph.91.3.508b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Resolution to improve the social conditions that contribute to health. Am J Public Health 2001; 91:518. [PMID: 11236458 PMCID: PMC1446619 DOI: 10.2105/ajph.91.3.518b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Effective public health assessment, prevention, response, and training for emerging and re-emerging infectious diseases, including bioterrorism. Am J Public Health 2001; 91:500-1. [PMID: 11236439 PMCID: PMC1446616 DOI: 10.2105/ajph.91.3.500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Establishment of a Medicare prescription drug benefit. Am J Public Health 2001; 91:519. [PMID: 11236460 PMCID: PMC1446580 DOI: 10.2105/ajph.91.3.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reducing the incidence of blindness, lower extremity amputation, and oral health complications in minority populations due to diabetes. Am J Public Health 2001; 91:478-9. [PMID: 11236425 PMCID: PMC1446618 DOI: 10.2105/ajph.91.3.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ensuring optimal vision performance in visually at risk drivers. Am J Public Health 2001; 91:510-1. [PMID: 11236450 PMCID: PMC1446594 DOI: 10.2105/ajph.91.3.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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