The proportion of persons under HIV care in the United States who had ever received HAART increased to over 70% of the affected population by January 1998 and the disparities in use between groups narrowed but did not disappear. However, nearly half of those eligible for HAART according to the U.S. Department of Health and Human Services guidelines were not actually receiving it nearly 2 years after these medications were first introduced. Strategies to promote the initiation and continuation of HAART are needed for those without contraindications and those who can tolerate it.
ObjectiveWe sought to determine the prevalence of any alcohol use and hazardous alcohol consumption among HIV-infected individuals engaged in care and to identify factors associated with hazardous alcohol use. MethodsDuring 2003, 951 patients were interviewed at 14 HIV primary care sites in the USA. Hazardous drinking was defined as 414 drinks/week or 5 drinks/occasion for men and 47 drinks/week or 4 drinks/occasion for women. Moderate alcohol use was consumption at less than hazardous levels. We used logistic regression to identify factors associated with any alcohol use and hazardous alcohol use. ResultsForty per cent of the sample reported any alcohol use in the 4 weeks prior to the interview; 11% reported hazardous use. In multivariate regression, male sex [adjusted odds ratio (AOR) 1.52 (95% confidence interval, CI, 1.07-2. ConclusionsAlcohol use is prevalent among HIV-infected individuals and is associated with a variety of socioeconomic and demographic characteristics. Screening for alcohol use should be routine practice in HIV primary care settings.
Objective The aim of the study was to assess the prevalence of and factors associated with use of complementary or alternative medicine (CAM) in a multistate, multisite cohort of HIV‐infected patients. Methods During 2003, 951 adult patients from 14 sites participated in face‐to‐face interviews. Patients were asked if they received treatment from any alternative therapist or practitioner in the previous 6 months. Logistic regression was performed to examine associations between demographic and clinical variables and CAM use. Results The majority of the participants were male (68%) and African American (52%) with a median age of 45 years (range 20–85 years). Sixteen per cent used any CAM in the 6 months prior to the interview. Factors associated with use of CAM were the HIV risk factor injecting drug use [adjusted odds ratio (AOR) 0.51] compared with men who have sex with men (MSM), former drug use (AOR=2.12) compared with never having used drugs, having a college education (AOR=2.43), and visiting a mental health provider (AOR=2.76). Conclusions This study demonstrated similar rates of CAM use in the current highly active antiretroviral therapy (HAART) era compared with the pre‐HAART era. Factors associated with CAM – such as education, use of mental health services, and MSM risk factor – suggest that CAM use may be associated with heightened awareness regarding the availability of such therapies. Given the potential detrimental interactions of certain types of CAM and HAART, all HIV‐infected patients should be screened for use of CAM.
Introduction Risk adjusted thirty-day hospital readmission rate is a commonly used benchmark for hospital quality of care and for Medicare reimbursement. Persons living with HIV (PLWH) may have high readmission rates. This study compared 30-day readmission rates by HIV status in a multi-state sample with planned subgroup comparisons by insurance and diagnostic categories. Methods Data for all acute care, non-military hospitalizations in 9 states in 2011 were obtained from the Healthcare Costs and Utilization Project. The primary outcome was readmission for any cause within 30 days of hospital discharge. Factors associated with readmission were evaluated using multivariate logistic regression. Results 5,484,245 persons, including 33,556 (0.6%) PLWH, had a total of 6,441,695 index hospitalizations, including 45,382 (0.7%) among PLWH. Unadjusted readmission rates for hospitalizations of HIV-uninfected persons and PLWH were 11.2% (95% CI: 11.2, 11.2) and 19.7% (19.3, 20.0), respectively. After adjustment for age, gender, race, insurance, and diagnostic category, HIV was associated with 1.50 (1.46, 1.54) times higher odds of readmission. Predicted, adjusted readmission rates were higher for PLWH within every insurance category, including Medicaid (12.9% [12.8, 13.0] and 19.1% [18.4, 19.7] for HIV-uninfected persons and PLWH, respectively) and Medicare (13.2% [13.1, 13.3] and 18.0% [17.4, 18.7], respectively) and within every diagnostic category. Discussion HIV is associated with significantly increased readmission risk independent of demographics, insurance, and diagnostic category. The 19.7% 30-day readmission rate may serve as a preliminary benchmark for assessing quality of care of PLWH. Policymakers may consider adjusting for HIV when calculating a hospital’s expected readmission rate.
In expansion state sites, half of PLWH relying on RWHAP/Uncomp coverage shifted to Medicaid, while in New York and nonexpansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net provider visit coverage.
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