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Medicineworld.org: HIV-positive individuals with inadequate care

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HIV-positive individuals with inadequate care

HIV-positive individuals with inadequate care
In a first-of-its-kind study, UCLA scientists have shown that segments of the HIV-infected population who have little to no consistent outpatient medical care -- and yet are most in need of such services -- are overwhelmingly minorities, the poor and substance abusers.

Prior studies had shown minorities, the poor and substance users who were receiving routine medical care for the HIV infection, and whose data could therefore be easily captured in healthcare studies, were likelier to be medically underserved and to die more quickly. But Dr. William Cunningham, and the study's lead author, said UCLA scientists tracked HIV-infected people who were not receiving regular care -- and thus more difficult to find. Often this segment showed up in the medical system in emergency situations.

"As we expected, they are much less likely to get routine outpatient care but more likely to get acute care, when they are at their sickest," said Cunningham, who is professor of medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA. "This is just the group that needs to get grassroots outreach service".

For this study, would be reported in the recent issue of the journal Medical Care, the scientists compared socio-demographic, clinical and health care utilization characteristics of HIV-infected adults from two samples: 1,286 people from the 2001-02 Targeted HIV Outreach and Intervention Initiative (Outreach) and 2,267 who were interviewed in 1998 for the HIV Costs and Services Utilization Study (HCSUS).

Outreach, a multi-site program initiated in 2001 under the Ryan White Care Act, was intended to locate HIV-infected people who are hard to reach and connect them with medical care. HCSUS focused on HIV-positive patients who were receiving care.

The 16 Outreach study sites, which were spread throughout the U.S., offered a variety of services such as HIV testing and counseling, social services, case management and direct medical care. They all provided outreach services linking HIV-positive patients with continuous outpatient care. The scientists examined the demographic data, the kinds of medical services the patients used and which services would be the most helpful to them.

As per the study, 59 percent of patients in the Outreach group were black, compared with 32 percent of HIV-infected people who were receiving routine care and were tracked by HCSUS. Also, 20 percent of those from the Outreach sites were Hispanic versus 16 percent from the HCSUS sample; 9 percent were Spanish speakers in comparison to 2 percent; 75 percent had annual incomes of $10,000 or less compared with 45 percent; and nearly 60% were unemployed, homeless, had no insurance or used heroin or cocaine compared with less than half in the HCSUS study.

Additionally, people from the Outreach group received medical care on an outpatient basis two times or less, but were likelier to have gone to emergency rooms or been hospitalized, during the previous six months. They were also less likely to be on antiretroviral drugs. And surprisingly, these patients were also more likely to have abused alcohol than drugs.

The findings can be used to develop novel interventions specifically tailored to this group, such as mobile HIV testing facilities and bringing HIV therapy to single occupancy hotels, which are typically home to drug abusers, sex workers and other marginalized people.

"Because we did this study, we know better what kind of services to tailor to them," Cunningham said. "They're not the same kind of services that are important to more mainstream patients".


Posted by: Mark    Source




Did you know?
In a first-of-its-kind study, UCLA scientists have shown that segments of the HIV-infected population who have little to no consistent outpatient medical care -- and yet are most in need of such services -- are overwhelmingly minorities, the poor and substance abusers. Prior studies had shown minorities, the poor and substance users who were receiving routine medical care for the HIV infection, and whose data could therefore be easily captured in healthcare studies, were likelier to be medically underserved and to die more quickly. But Dr. William Cunningham, and the study's lead author, said UCLA scientists tracked HIV-infected people who were not receiving regular care -- and thus more difficult to find. Often this segment showed up in the medical system in emergency situations.

Medicineworld.org: HIV-positive individuals with inadequate care

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