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Service utilization by HIV-1 infected women from four United States urban centers: the HERS study.
Solomon L; Stein M; Flynn CP; Schoenbaum E; Moore J; Schuman P; Holmberg
January 30, 1997
Int Conf AIDS. 1996 Jul 7-12;11(2):20 (abstract no. We.B.176). Unique

Objective: To characterize health services utilization among urban women with, and at risk, for HIV-1 infection. Methods: 1293 women at risk for HIV-1 infection were recruited at four urban centers (Baltimore, The Bronx, Detroit, and Providence). At a baseline study visit the women received physical examinations, had specimens drawn for CD4 counts, and completed questionnaires detailing health service utilization, HIV risk behavior, and clinical data. Results: 863 women were HIV-1 seropositive and 430 were HIV-1 seronegative. 52% were injection drug users (IDU) and 48% heterosexual risk group. 57% were African-American, 23% were white, and 16% were Hispanic. The median age was 34, median income was less than $1000 per month, 58% were on welfare, and 19% were employed. 68% of the seropositives had CD4+ cell counts less than 500/mm3 including 17% with counts less than 200/mm3. 36% of the seropositives were symptomatic. 86% of HIV seropositives and 64% of the seronegatives had an outpatient visit in the last 6 months p is less than 0.001. 89% of seropositive women and 74% of seronegative women reported having a usual doctor or clinic where they get care (p is less than 0.001), however, emergency room (ER) use in the last 6 months was high among both the seronegatives, (37%), and the seropositives 49%) (p is less than 0.001). Fewer HIV seronegative women were hospitalized than HIV seropositive women (12% vs. 22%; p is less than 0.001). Despite heavy utilization of health services, utilization of anti-retroviral therapy by women with less than 200 CD4/mm3 cells was only 49% at the baseline study visit and use of PCP prophylaxis was only 58%. Notably, ever use of antiretrovirals was 89% and of PCP prophylaxis was 82% in this group, suggesting that many women have begun HIV clinical care, but are using prophylaxis intermittently. After adjusting for CD4+ count and HIV symptom status, IDUs were significantly less likely to report having a regular doctor, a recent outpatient visit, ER visit, or to use opportunistic infection (OI) prophylaxis for diseases other than PCP (i.e., antifungals). Race did not significantly predict health service utilization among these women. Conclusion: Although women had high levels of use of services, utilization of antiretrovirals and OI prophylaxis was low throughout, and IDUs were the lowest utilizers of HIV-related health services.

*Antiviral Agents *HIV Infections/EPIDEMIOLOGY *Substance Abuse, Intravenous *Urban Health Services/UTILIZATION