More than ancillary: HIV social services, intermediate outcomes and quality of life

Abstract

In HIV care, the use of social or “ancillary” services to stabilize life situations and remove barriers to care is often seen as a means to the end of ensuring more consistent participation in medical care. By examining the impact of HIV social services on the achievement of intermediate outcomes (i.e., ceasing substance use, initiating anti-retroviral therapy (ART), and entering stable housing) and the relationship between intermediate outcome status and quality of life (QOL), our analysis aims to demonstrate the importance of achieving intermediate outcomes in and of themselves and thereby the importance of the ancillary services that assist clients in attaining desired intermediate outcomes.

Our analysis relies on baseline and follow-up data from 1646 HIV-positive participants collected during a longitudinal outcome evaluation of 23 HIV social service programs in the New York metropolitan area. Multivariate linear regression modeling was used to assess the impact of achieving intermediate outcomes on QOL at follow-up, controlling for baseline QOL, and demographic factors.

The greatest improvements in QOL were found in individuals who changed their intermediate outcome status from using drugs to not using, from not using ART to using ART, and from being unstably housed to being stably housed. Our analysis strongly suggests the importance of achieving intermediate outcomes in improving QOL, and thereby the importance of social services that facilitate the achievement of these intermediate outcomes. The analysis also provides further validation of a QOL measure, by showing that it varies in systematic and expected ways with the achievement of intermediate outcomes. Our study suggests that social services are not merely ancillary in HIV care but rather crucial for achieving both intermediate outcomes as well as the final outcome of improved QOL.

Keywords:

• HIV
• social services
• quality of life
• intermediate outcomes
• substance use
• housing
• anti-retroviral therapy
• Latinos
• African Americans

Acknowledgements

The authors thank the clients who participated in the evaluation and the agencies that served them. The programs and evaluation activities described were funded with Congressional Minority AIDS Initiative funds from the US Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, with the support of the New York HIV Health and Human Services Planning Council, through the New York City Department of Health & Mental Hygiene, and Medical and Health Research Association of New York City, Inc. The views and conclusions expressed in this paper are solely the responsibility of the authors and do not necessarily represent the official views of the funders.