Differences in patient and clinic characteristics at CARE Act funded versus non-CARE Act funded HIV clinics

Abstract

The Ryan White CARE Act supports comprehensive care to persons with HIV infection. With an annual budget of over $1 billion, it is the largest federally funded programme for HIV care in the USA. We analysed data from the HIV Costs and Services Utilization Study, a nationally representative sample of HIV patients. Patient data were collected in 1996–97 and clinic data were collected in 1998–99. We examined whether CARE Act funded clinics differed from other HIV clinics in (1) the characteristics of their patients, and (2) their organization, staffing, and services. We found that patients at CARE Act clinics were younger, less educated, poorer, and more likely to be female, non-white, unemployed, uninsured, and have heterosexual contact as an HIV risk factor, compared to patients at other HIV clinics. CARE Act clinics tended to specialize in HIV care, had more infectious disease specialists, had fewer total patients, and provided more support services (e.g. mental health, nutrition, case management, child care). These results are consistent with findings of other studies that were limited by non-probability samples or restricted geographical areas.

Acknowledgments

Work on this study was supported by grants from the Robert Wood Johnson Foundation, the Agency for Healthcare Research and Quality (R01 HS1040802 and R01HS10227), a cooperative agreement (U-01HS08578) between RAND and the Agency for Healthcare Research and Quality, and the Aetna Quality Forum. The authors also wish to thank Lisa Hirschhorn for her comments on earlier drafts of this manuscript, and Lin Ding, for the analytical computing.