Association between ancillary services and clinical and behavioral outcomes among HIV-infected women.
The purpose of this study was to evaluate the association between ancillary services, including case management, and clinical and behavioral outcomes for human immunodeficiency virus (HIV)-infected women. Data were obtained from databases systematically maintained by Family Advocacy, Care and Education Services (FACES) and the HIV Outpatient Program (HOP) in New Orleans. HIV-infected women receiving primary care from HOP and ancillary services from FACES between January 1, 1997 and December 31, 1998 were eligible. Data were analyzed using generalized estimating equations (GEE) with STATA software. The majority of women included in the study were African American (86.7%), infected heterosexually (78.8%), and had absolute CD4 counts greater than 200 (58.6%). After adjusting for age, time, entry time into HOP, pregnancy, CD4 count, substance abuse status, and social and clinical stressors, receipt of more than four combined case manager contacts or ancillary services per month was significantly associated with being prescribed a protease inhibitor, improved adherence and retention in primary care, and enrolling on a research protocol. Receiving more than one transportation service per month was significantly associated with improved adherence, improved retention, one or more emergency room visits per month, and one or more hospitalizations per month. Receiving more than one contact with case managers per month was associated with improved retention in primary care. Findings suggest that receipt of case management and ancillary services is associated with improvements in multiple outcomes for HIV-infected women. A client-centered approach to providing ancillary services appears to be effective in improving behavioral and utilization characteristics in this population of low-income, high-risk women.
Magnus
M
M
Tulane University, School of Public Health and Tropical Medicine, Department of Epidemiology, New Orleans, Louisiana 70112, USA. manyadm@tulane.edu
Schmidt
N
N
Kirkhart
K
K
Schieffelin
C
C
Fuchs
N
N
Brown
B
B
Kissinger
P J
PJ
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D000720:Ancillary Services, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D019090:Case Management / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology*; D006302:Health Services Research; D006801:Humans; D008145:Louisiana; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011203:Poverty; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D015397:Program Evaluation; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications; D014186:Transportation; D016896:Treatment Outcome; D019562:Viral Load; D016387:Women's Health