title: Estimation of unmet need for HIV primary medical care: a framework and three case studies.
abstract: Reauthorization of the Ryan White Comprehensive AIDS Resources Emergency Act requires that each jurisdiction estimate the number of people living with HIV/AIDS who have unmet need for care. Past assessments of unmet need have used various definitions of care, relied on qualitative evaluations, or examined nonrepresentative subpopulations. This article outlines a single, flexible framework designed to quantitatively estimate unmet need in varied settings. The framework adopts a definition of unmet need which focuses on HIV primary medical care (CD4 test, viral load test, or antiretroviral therapy in a 12-month period), employs a standard analytic structure to integrate population and care data, and allows use of locally available data. We report on three field tests (Louisiana, Atlanta, and San Francisco). The field tests suggest that the unmet need framework provides an approach which can be used by states and metropolitan areas to estimate the number of individuals with unmet need for HIV primary medical care.
authors.affiliation: Institute for Health Policy Studies, University of California, San Francisco 94143, USA. kikard@itsa.ucsf.edu
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ikard
authors.forename: Jays
authors.initials: J
authors.lastname: Janney
authors.forename: Ling Chin
authors.initials: LC
authors.lastname: Hsu
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Isenberg
authors.forename: M Beth
authors.initials: MB
authors.lastname: Scalco
authors.forename: Sandra
authors.initials: S
authors.lastname: Schwarcz
authors.forename: Linda
authors.initials: L
authors.lastname: Beer
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Wendell
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Franks
authors.forename: James G
authors.initials: JG
authors.lastname: Kahn
mesh_terms: D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration*; D019982:Organizational Case Studies; D011320:Primary Health Care; D014481:United States