Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics.
BACKGROUND
Women with HIV infection have lagged behind men in receipt of critical health care, but it is not known if those disparities are due in part to where women receive care. We examined differences in care received by HIV-infected women and men in a national sample of Ryan White CARE Act-funded clinics and explored the influence of clinic characteristics on care quality.


METHODS
Record review was done on a sample of 9,015 patients who received care at 69 CARE Act-funded HIV primary care clinics that participated in a quality improvement study. Outcome measures studied were highly active antiretroviral therapy (HAART) use, HIV viral suppression, Pneumocystis jiroveci pneumonia (PCP) prophylaxis, screening, and other disease prevention efforts.


RESULTS
Women were less likely than men to receive HAART (78% versus 82%, p < .001), receive PCP prophylaxis (65% versus 75%, p < .0001), or have their hepatitis C virus status known (87% versus 88%, p = .02) despite being seen more regularly (69% versus 66%, p = .04). Sites serving high percentages of women delivered similar or better care for both men and women than other sites. Although sites serving a higher percent of women had more support services such as case management and onsite obstetrician-gynecologists and provided Pap smears at higher rates, women at such sites remained less likely than men to receive important HIV care including HAART and PCP prophylaxis.


CONCLUSIONS
The gap in the quality of care provided to HIV-infected men and women in critical areas persists, and is not explained by the types of sites where men and women receive care.
Hirschhorn
Lisa R
LR
Harvard Medical School Division of AIDS, The Landmark Center, Harvard Medical School, Boston, Massachusetts 02215, USA. LRH3@HMS.Harvard.edu
McInnes
Keith
K
Landon
Bruce E
BE
Wilson
Ira B
IB
Ding
Lin
L
Marsden
Peter V
PV
Malitz
Faye
F
Cleary
Paul D
PD
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D016387:Women's Health