title: Quality of care for HIV infection provided by Ryan White Program-supported versus Non-Ryan White Program-supported facilities.
abstract: BACKGROUND
  The Ryan White HIV/AIDS Care Act (now the Treatment Modernization Act; Ryan White Program, or RWP) is a source of federal public funding for HIV care in the United States. The Health Services and Resources Administration requires that facilities or providers who receive RWP funds ensure that HIV health services are accessible and delivered according to established HIV-related treatment guidelines. We used data from population-based samples of persons in care for HIV infection in three states to compare the quality of HIV care in facilities supported by the RWP, with facilities not supported by the RWP.
  
  
  RESULTS
  Within each area (King County in Washington State; southern Louisiana; and Michigan), a probability sample of patients receiving care for HIV infection in 1998 was drawn. Based on medical records abstraction, information was collected on prescription of antiretroviral therapy according to treatment recommendations, prescription of prophylactic therapy, and provision of recommended vaccinations and screening tests. We calculated population-level estimates of the extent to which HIV care was provided according to then-current treatment guidelines in RWP-supported and non-RWP-supported facilities. For all treatment outcomes analyzed, the compliance with care guidelines was at least as good for patients who received care at RWP-supported (vs non-RWP supported) facilities. For some outcomes in some states, delivery of recommended care was significantly more common for patients receiving care in RWP-supported facilities: for example, in Louisiana, patients receiving care in RWP-supported facilities were more likely to receive indicated prophylaxis for Pneumocystis jirovecii pneumonia and Mycobacterium avium complex, and in all three states, women receiving care in RWP-supported facilities were more likely to have received an annual Pap smear.
  
  
  CONCLUSIONS
  The quality of HIV care provided in 1998 to patients in RWP-supported facilities was of equivalent or better quality than in non-RWP supported facilities; however, there were significant opportunities for improvement in all facility types. Data from population-based clinical outcomes surveillance data can be used as part of a broader strategy to evaluate the quality of publicly-supported HIV care.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. patrick.sullivan@emory.edu
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.forename: Maxine
authors.initials: M
authors.lastname: Denniston
authors.forename: Eve
authors.initials: E
authors.lastname: Mokotoff
authors.forename: Susan
authors.initials: S
authors.lastname: Buskin
authors.forename: Stephanie
authors.initials: S
authors.lastname: Broyles
authors.forename: A D
authors.initials: AD
authors.lastname: McNaghten
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D005260:Female; D005380:Financing, Government / Q000191:economics; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D014481:United States; D014488:United States Health Resources and Services Administration