Access to HIV Care: Lack of Insurance Among Patients in a Large Public Health System

Background: This project sought to identify patient characteristics that would be predictors of receiving high quality primary HIV care consistent with PHS guidelines.

Methods: Our data source was patient level data in the Ryan White Care Act Title I HIV primary care system for the Philadelphia EMA. The data set contained demographic and clinical information on patients who had at least one medical visit at one of 26 primary care sites between March 2005 and February 2006. We defined quality HIV care as receiving three viral loads during the period based on PHS guidelines for the treatment of HIV infection. We used logistic regression to identify predictors of quality HIV care during this time period.

Results: Of the 6,290 patients in the data set, 15.8% did not have any form of health insurance. The uninsured patients were significantly less likely (18.8%) than insured patients (26%) to receive high quality HIV care. This difference remains after controlling for race, ethnicity, gender, age, risk type and service agency patient population size. In addition to the insured, Blacks and Hispanics were significantly more likely to receive high quality HIV care than were Whites, and patients >45 years also received higher quality care.

Conclusion: Insurance status is a significant factor in predicting receipt of high quality HIV care in the Ryan White funded Title I system of HIV care in Philadelphia. Public health programs are well situated to address this patient characteristic and overcome disparities in care.