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APHA Scientific Session and Event Listing

Recorded presentation

Stephanie L. Taylor, PhD, MPH¹, Chloe E. Bird, PhD¹, Rebecca Collins, PhD¹, and William E. Cunningham, MH, MPH². (1) Health, RAND, PO Box 2138, M5S, Santa Monica, CA 90034, 310-393-0411 x7965, staylor@rand.org, (2) Health Services Research, UCLA, 31-254A CHS, Los Angeles, CA 90095

Objective: For several types of medical service utilization, the amount of care one receives has been shown to correlate with where one resides in the U.S. Among persons with HIV/AIDS, few have examined this issue and only explored how the region of the country mattered without identifying geographic characteristics accounting for the disparities in care. We examined regional variation in medical care and four regional characteristics as potential correlates of that variation. Methods: We used a nationally-representative sample of adults with HIV and in medical care in the U.S. - the HIV Cost and Services Utilization Study's late 1998 survey. We examined, over a six month period, use of any: 1)inpatient visits, 2) emergency room visits without hospitalization, 3) antiretrovirals, 4) pneumonia prophylaxis (PCP), and 5) outpatient visits. Multi-level analyses accounted for the 1,385 persons nested in 28 metropolitan statistical areas (MSAs) and controlled for eleven individuals characteristics. Results: Persons residing in MSAs with fewer AIDS cases and more teaching hospitals were more likely to receive any PCPs. Those living in MSAs with more AIDS-designated hospitals were more likely to receive an inpatient visit. Persons living in MSAs with higher percentages of infectious disease specialists were more likely to receive at least one outpatient visit. However, the amount of Ryan White funding in an MSA was unrelated to the services. Conclusions: The data suggest that medical care for person with HIV is a complex interaction between the disease epidemiology (where the cases are located) and larger, structural issues.

Learning Objectives: The audience will learn

• The regional characteristics that correlate with several aspects of HIV care in the US
• The basics of conducting a multi-level analysis of persons nested within geographic regions

Keywords: HIV/AIDS, Service Delivery

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation