In a setting where treatment for HIV is free of charge, a significant number of HIV-positive persons did not access HAART. Low socioeconomic status was associated with this delay and with increased mortality among persons receiving HAART. Social and health policy initiatives, beyond free and universal health care, are required to optimize access to HAART.

ObjectiveTo report emerging data on the use of highly active antiretroviral therapy (HAART) in Argentina by assessing patterns of HAART access and late vs early treatment initiation in a population-based cohort of adults infected with HIV type-1.DesignThe Prospective Study on the Use and Monitoring of Antiretroviral Therapy (PUMA) is a study of 883 HIV-positive individuals enrolled in the Argentinean drug treatment program. Individuals were 16 years of age and older and were recruited from 10 clinics across Argentina.MethodsSociodemographic and clinical characteristics were examined using contingency tables (Pearson chi-square test and Fisher exact test) for categoric variables and Wilcoxon rank-sum test for continuous variables. To analyze time to initiation of HAART we used Kaplan-Meier methods and Cox regression.ResultsPatients who initiated HAART were more likely to be older, have an AIDS-defining illness, be an injection drug user (IDU), have a lower median CD4 cell count, have a higher median viral load, and be less likely to be men who have sex with men (MSM). In multivariate analysis, AIDS-defining illness and plasma viral load were significantly associated with time to starting therapy. Patients who received late access were more likely to be diagnosed with AIDS and have higher median plasma viral loads than those receiving early access.ConclusionOur results indicate that despite free availability of treatment, monitoring, and care in Argentina, a significant proportion of men and women are accessing HAART late in the course of HIV disease. Further characterization of the HIV-positive population will allow for a more comprehensive evaluation of the impact of HAART within the Argentinean drug treatment program.

ObjectiveThe aim of the study was to determine rates of utilization of in-patient, out-patient and laboratory services stratified by virological and immunological markers of HIV disease among patients on antiretroviral treatment in British Columbia, Canada. MethodsWe estimated resource utilization for in-patient visits, out-patient visits, and laboratory tests among patients initiating antiretroviral treatment between 1 April 1994 and 31 December 2000, with follow-up to 31 March 2001. Resource use was stratified by CD4 cell count and plasma HIV viral load (pVL) at the time of utilization and rates per 100 patient-years were calculated for each health care resource. ResultsA total of 2718 patients were included in our analyses. The overall rates of in-patient visits, out-patient visits, and laboratory tests were 902, 3001 and 840 per 100 patient-years, respectively. Utilization was higher for patients with low CD4 cell counts and high pVLs when compared with patients with high CD4 cell counts and low pVLs. ConclusionsPatients with low CD4 cell counts and high pVLs had the highest use of health care services. Regular follow-up with health care providers in an out-patient setting, allowing for proper monitoring and maintenance of HIV care, is important in minimizing unnecessary and potentially costly in-patient care.Keywords: antiretroviral therapy, health care utilization, HIV/AIDS Accepted 29 July 2008Introduction Regular access to out-patient care and regular follow-up can allow patients to properly manage health conditions and avoid unnecessary hospitalization [1][2][3]. This is especially important for patients with chronic infectious diseases such as HIV/AIDS [4]. A sharp decrease in HIV/ AIDS-related morbidity and mortality can be attributed to the introduction of highly active antiretroviral therapy (HAART) in 1996 for the treatment of HIV infection; patients are now living longer and require long-term treatment and management of their disease [4][5][6].Decreases in hospitalization rates among HIV-positive patients have also been documented since the introduction of HAART [7][8][9][10][11][12]. However, many factors still contribute to the use of in-patient care among this population. For example, comorbidities such as hepatitis C virus coinfection, drug-related abscesses and antiretroviral-related adverse events may compromise adherence to HAART and therefore generate excess morbidity and mortality [13][14][15]. With regular follow-up in an out-patient setting, however, patients can more easily manage their disease and MethodsData for this study were drawn from the BC Centre for Excellence's Drug Treatment Program (DTP) and BC Ministry of Health administrative databases. In the province of BC all antiretroviral medications are centrally distributed through the DTP and provided free of charge to clinically eligible HIV-infected individuals. Details of the distribution of medications through the DTP have previously been described in detail [18]. Health care in the province is provided by the publicly insure...