title: A national study of the relationship of care site HIV specialization to early adoption of highly active antiretroviral therapy.
abstract: BACKGROUND
  Little is known about characteristics of organizations that predict early adoption of highly active antiretroviral therapy (HAART) for persons with HIV infection.
  
  
  OBJECTIVE
  To describe characteristics of sites where HIV care is provided and to assess site characteristics that predict early adoption of HAART.
  
  
  METHODS
  Cross-sectional analysis of survey data from patients, HIV physicians, and medical directors.
  
  
  METHODS
  Participants in the HIV Cost and Services Utilization Study, a national probability sample of persons with HIV who received outpatient care in the continental United States during 1996.
  
  
  METHODS
  Rates of exposure to HAART by December 1996.
  
  
  RESULTS
  Nationally, 79% of patients were treated at sites specializing in HIV care (HIV sites). Over 90% of patients were cared for by physicians who were experts in HIV care, either infectious disease specialists (46%) or general medicine experts (45%). Adjusted rates of exposure to HAART by December 1996 varied from 0.02 to 0.79 across sites (mean rate, 0.33). In multivariable models, HIV specialization (odds ratio [OR], 3.6; P < 0.001), total patient volume of more than 20,000 visits a year (OR, 2.1; P < 0.01), and educational level of the zip code in which the site was located (OR, 1.2 for each 10% increase in college education) were associated with higher rates of exposure to HAART. These effects persisted after adjustment for physician HIV expertise. Site effects were more important than physician effects in explaining rates of exposure to HAART.
  
  
  CONCLUSIONS
  In 1996 there were wide variations in rates of HAART use by site of care. Low-volume sites that do not specialize in HIV care should take measures to ensure that HIV expertise is available to their patients.
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, Massachusetts, USA.
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Lin
authors.initials: L
authors.lastname: Ding
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Martin F
authors.initials: MF
authors.lastname: Shapiro
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Bozzette
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008511:Medicine; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D013038:Specialization; D014481:United States