158299 Case management outcomes among HIV/AIDS patients: A case of the Latino Paradox?

Monday, November 5, 2007: 9:30 AM

Diana Romero, PhD, MA , Department of Population and Family Health, Columbia University, New York, NY
Georgina Osorio, MD , Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY
Catherine Correa , Ryan White Title I Services, Bergen-Passaic EMA, Paterson Dept of Human Services, Paterson, NJ
Jesse Thomas , RDE Systems, Clifton, NJ
  
Background: In 1994 Passaic and Bergen Counties (NJ) were designated an eligible metropolitan area (EMA) per the Ryan White CARE Act. In 2004 a web-based data system, eCOMPAS, was implemented to permit quantitative analyses of provider and client data.

Methods: Analysis of the eCOMPAS dataset was conducted of Case Management provider surveys (n=3,805; 8/04-6/06). We examined four outcomes: HIV regimen adherence, patient skills, compliance with medical and case management appointments. Bivariate analysis was conducted with the following variables: HIV status, race/ethnicity, gender, income source, employment, ability to work, county of residence, social network, housing, caregiver support, health insurance. Significant variables were included in multivariate models for all four outcomes.

Results: Sample characteristics were as follows: 21% AIDS (vs. 79% HIV-positive), 55% male, 69% Black, 23% White, 8% Latino, 75% unemployed, 47% welfare, 70% Medicaid, mean age 43 years. Bivariate analysis revealed several factors associated with poor outcomes: AIDS status, non-Latinos, male gender, welfare, no Medicaid. Covariates that persisted in the multivariate analyses included AIDS, welfare, and insurance status, income, county of residence, and race/ethnicity. Latino ethnicity was significantly associated with favorable outcomes for all four measures compared with Black and White clients.

Conclusions: Except for AIDS status, outcomes varied primarily by social and demographic characteristics, which may be responsive to policy changes. The better outcomes noted among Latinos in the sample warrants further examination given persistent health disparities experienced by racial/ethnic minorities in the US. These findings may provide another context in which to understand the “Latino Paradox,” a phenomenon in which Latino populations appear to (unexpectedly) fare better than the majority population. Finally, to our knowledge, this is the first research application of web-based provider data from a Ryan White EMA, which may inform health services, policies, and funding.

Learning Objectives:
1) Articulate the goals of Ryan White Title I funding to EMAs and the primary services delivered 2) Describe select case-management outcomes measured in Ryan White funded services of the Bergen-Passaic EMA 3) Describe the "Latino Paradox" (also referred to as the "epidemiologic paradox") and assess its policy and health relevance in the context of an HIV/AIDS population in northern New Jersey

Keywords: HIV/AIDS, Latino Health

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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