A Needs Assessment for HIV-Positive Clients Receiving Ryan White-funded services

Background: HRSA, the primary funder of HIV care for low-income persons in the US, requires each jurisdiction receiving Ryan White(RW) funding to justify need, set priorities and conduct resource allocation using evidence-based data. Methods were developed to identify a representative sample of the 18,545 HIV+ RW clients in Los Angeles County(LAC) for purposes of a needs assessment. Methods: A cross-sectional, two-stage, proportional-to-size sampling design was used to identify a statistically representative sample of facilities(n=46) and participants(n=450) from January-April 2010. Facilities were stratified by type(e.g.,medical, housing/transportation, substance abuse, social services) to ensure proportional representation. Real-time sampling was used to identify and recruit participants. Data were collected on demographics, service awareness, needs, services received, satisfaction with services, needed services that were not received(e.g., gaps) and barriers. Logistic regression analysis was used to examine factors associated with gaps. The facility and participant response rate were 100% and 94% respectively. Results: Awareness of services was high(99%) and all reported a need for at least one service. The majority of participants reported at least one service gap(81%) and homelessness was associated with the presence of a service gap(OR=3.7;95%CI:1.1-12.4). Among Latinos, low income was associated with a service gap(OR=3.0;95%CI:1.4-6.7). The largest individual service gap was for dental services(34%) and incarceration(OR=2.7;95%CI:1.2-6.1), lack of health insurance(OR=1.8;95%CI:1.2-2.9) and substance use(OR=1.8;95%CI:1.1-2.8) were associated with this gap. Common barriers were individual (e.g.,not knowing where to go/who to call). Conclusion: Methods were developed to obtain a representative sample of client data that can reliably be used for priority setting and resource allocation.