title: Who's in and who's out: use of primary medical care among people living with HIV.
abstract: OBJECTIVE
  We sought to achieve a more comprehensive picture of access to medical care for the treatment of HIV (HIV primary care) by combining evidence of medical services used (health utilization) and epidemiological client-level data.
  
  
  METHODS
  This study integrated health information from several data sources to measure utilization of HIV primary care in the St Louis, Mo, area between 1998 and 2002. Data from disparate HIV health utilization databases were combined with data from the Missouri HIV and AIDS Reporting System database and then deidentified to measure client-level utilization of HIV primary care over time.
  
  
  RESULTS
  About half of those with HIV showed evidence of having utilized HIV primary care in a given year. Although most of this group utilized HIV primary care in the first year after they received their HIV diagnosis, evidence of subsequent utilization was inconsistent. Utilization of primary care was most strongly associated with an AIDS diagnosis. About one quarter of people diagnosed with HIV after 1997 had an AIDS diagnosis when they first tested positive for HIV.
  
  
  CONCLUSIONS
  This study was the first of its kind to integrate several databases to understand HIV primary health care utilization over a period of years. Our findings reinforce the importance of CD4 and viral load values as indicators of utilization of HIV primary health care, particularly in the absence of other health data sets. The lack of available data and the way in which source data were available limited the study.
authors.affiliation: Policy Resource Group LLC, Indianapolis, Ind 46055, USA. bmeyerson@policyresourcegroup.com
authors.forename: Beth E
authors.initials: BE
authors.lastname: Meyerson
authors.forename: W Dean
authors.initials: WD
authors.lastname: Klinkenberg
authors.forename: Donna R
authors.initials: DR
authors.lastname: Perkins
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Laffoon
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008923:Missouri; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019562:Viral Load