Participation in research and access to experimental treatments by HIV-infected patients.
BACKGROUND
Although there is concern that minority groups and women are underrepresented in research involving patients with human immunodeficiency virus (HIV) infection, the available data are inconclusive.


METHODS
We used nationally representative data from the HIV Cost and Services Utilization Study to determine the characteristics of the participants and nonparticipants in trials of medications for HIV infection and whether or not patients had access to experimental treatments. A probability sample of 2864 persons, representing all 231,400 adults with known HIV infection who are cared for in the contiguous United States, were interviewed on three occasions between 1996 and 1998. They were asked about participation in clinical research studies of medications and past receipt of experimental medications for HIV.


RESULTS
We estimate that 14 percent of adults receiving care for HIV infection participated in a medication trial or study; 24 percent had received experimental medications; and 8 percent had tried and failed to obtain experimental treatments. According to multivariate models, non-Hispanic blacks and Hispanics were less likely to be participating in trials than non-Hispanic whites (odds ratio for participation among non-Hispanic blacks, 0.50 [95 percent confidence interval, 0.28 to 0.91]; odds ratio among Hispanics, 0.58 [95 percent confidence interval, 0.37 to 0.93]) and to have received experimental medications (odds ratios, 0.41 [95 percent confidence interval, 0.32 to 0.54] and 0.56 [95 percent confidence interval, 0.41 to 0.78], respectively). Patients who were cared for in private health maintenance organizations were less likely to participate in trials than those with fee-for-service insurance (odds ratio, 0.43 [95 percent confidence interval, 0.21 to 0.88]). Women were not underrepresented in research trials and had a similar likelihood of receiving experimental treatments.


CONCLUSIONS
Among patients with HIV infection, participation in research trials and access to experimental treatment is influenced by race or ethnic group and type of health insurance.
Gifford
Allen L
AL
Center for Research in Patient-Oriented Care and the Quality Enhancement Research Initiative in HIV, Veterans Affairs San Diego Healthcare System, and the University of California, San Diego, California 92161, USA. agifford@ucsd.edu
Cunningham
William E
WE
Heslin
Kevin C
KC
Andersen
Ron M
RM
Nakazono
Terry
T
Lieu
Dale K
DK
Shapiro
Martin F
MF
Bozzette
Samuel A
SA
D000328:Adult; D001294:Attitude to Health; D044383:Black People; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D004341:Drug Evaluation / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000208:ethnology*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D035842:Research Subjects; D036302:Therapeutic Human Experimentation; D014481:United States; D044465:White People; D001741:Black or African American