Characteristics of a Nationally Representative Sample of HIV Care Facilities in the U.S

INTRODUCTION As life expectancy has increased for HIV patients, ongoing resources are needed for their care. Data on where patients receive care will inform service provision and resource allocation. We describe a nationally representative sample of HIV care facilities in the U.S.

METHODS We analyzed 2007 data from the Medical Monitoring Project (MMP), which uses multi-stage probability sampling to select HIV patients for interview and medical record abstraction. This analysis focuses on HIV care facilities where patients were selected. An HIV care facility is where providers requested CD4 count or viral load testing or prescribed antiretroviral drugs. Urbanization was determined using the standard OMB criteria for metropolitan areas.

RESULTS Of 807 facilities, urbanization information was available for 774 (98%) and other information for 699 (87%). Most (89%) were metropolitan facilities. Among those with information, 79% were privately owned, 23% were HMOs, 33% had primary care providers, 63% had HIV or infectious disease specialists, and 45% received Ryan White CARE Act funding. Nonmetropolitan facilities more frequently had primary care providers only (57% vs 44%), and less frequently had HIV/infectious disease specialists (40% vs 51%). Nonmetropolitan facilities also less frequently offered substance abuse treatment (8% vs 20%), HIV case management (41% vs 47%), or medication adherence (50% vs 57%) and HIV risk-reduction counseling (50% vs 56%).

CONCLUSIONS HIV care facilities were mainly private facilities with HIV care specialists, but in nonmetropolitan areas, they may be more often facilities with primary care providers only. Specialized services may not be fully available to patients in nonmetropolitan areas.