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. 1999 Apr;34(1 Pt 1):123–144.

Access and use of medications in HIV disease.

S R Smith 1, D M Kirking 1
PMCID: PMC1088988  PMID: 10201855

Abstract

OBJECTIVE: To examine if measures of access to medical care are associated with outpatient use of antiretroviral and Pneumocystis carinii pneumonia (PCP) medications among a cohort of individuals with HIV disease. DATA SOURCES: Adults who participated in a series of up to six interviews as part of the AIDS Costs and Services Utilization Survey (ACSUS). ACSUS, a panel survey of persons with HIV disease, was undertaken from 1991 through 1992. STUDY DESIGN: The Andersen Behavioral Model of Health Services Use provided the conceptual framework for the study. Logistic regression analyses with generalized estimating equations were conducted to determine the effects of predisposing, enabling, and need-for-care factors on the odds of antiretroviral or PCP medication use. The analytic sample consisted of 1,586 respondents whose 7,652 interviews provided the data. PRINCIPAL FINDINGS: The multivariate analysis showed that being female (OR = 0.76; 95% C.I. = 0.60-0.95), ages 15 to 24 years (OR = 0.64; 95% C.I. = 0.44-0.92), and having a hospitalization (OR = 0.73; 95% C.I. = 0.63-0.84) were associated with lower odds of using antiretrovirals. African American race (OR = 1.30; 95% C.I. = 1.04-1.62), having both public and private insurance (OR = 2.11; 95% C.I. = 1.47-3.03), attending counseling (OR = 1.17; 95% C.I. = 1.02-1.34), having a usual source of care (OR = 1.70; 95% C.I. = 1.38-2.11), and clinical trials participation (OR = 1.52; 95% C.I. = 1.23-1.87) were associated with a higher odds of use. Similar results were obtained for analyses of PCP medication use. CONCLUSIONS: Sociodemographic differences exist in access and use of prescription drugs within the ACSUS cohort. The results suggest that women and those ages 15 to 24 years have poor access to some medications that improve survival in HIV disease.

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Selected References

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  1. Aday L. A., Lee E. S., Spears B., Chung C. W., Youssef A., Bloom B. Health insurance and utilization of medical care for children with special health care needs. Med Care. 1993 Nov;31(11):1013–1026. doi: 10.1097/00005650-199311000-00004. [DOI] [PubMed] [Google Scholar]
  2. Andersen R., Newman J. F. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973 Winter;51(1):95–124. [PubMed] [Google Scholar]
  3. Blum S., Singh T. P., Gibbons J., Fordyce E. J., Lessner L., Chiasson M. A., Weisfuse I. B., Thomas P. A. Trends in survival among persons with acquired immunodeficiency syndrome in New York City. The experience of the first decade of the epidemic. Am J Epidemiol. 1994 Feb 15;139(4):351–361. doi: 10.1093/oxfordjournals.aje.a117007. [DOI] [PubMed] [Google Scholar]
  4. Buchanan R. J., Smith S. R. Drug-assistance programs funded by Title II of the Ryan White CARE Act: a survey of the states. AIDS Public Policy J. 1996 Winter;11(4):185–203. [PubMed] [Google Scholar]
  5. Crystal S., Sambamoorthi U., Merzel C. The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts. Health Serv Res. 1995 Oct;30(4):593–614. [PMC free article] [PubMed] [Google Scholar]
  6. Cunningham W. E., Bozzette S. A., Hays R. D., Kanouse D. E., Shapiro M. F. Comparison of health-related quality of life in clinical trial and nonclinical trial human immunodeficiency virus-infected cohorts. Med Care. 1995 Apr;33(4 Suppl):AS15–AS25. [PubMed] [Google Scholar]
  7. Diaz T., Chu S. Y., Sorvillo F., Mokotoff E., Davidson A. J., Samuel M. C., Herr M., Doyle B., Frederick M., Fann S. A. Differences in participation in experimental drug trials among persons with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Dec 15;10(5):562–568. [PubMed] [Google Scholar]
  8. Fleishman J. A., Hsia D. C., Hellinger F. J. Correlates of medical service utilization among people with HIV infection. Health Serv Res. 1994 Dec;29(5):527–548. [PMC free article] [PubMed] [Google Scholar]
  9. Graham N. M., Jacobson L. P., Kuo V., Chmiel J. S., Morgenstern H., Zucconi S. L. Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992. J Clin Epidemiol. 1994 Sep;47(9):1003–1012. doi: 10.1016/0895-4356(94)90115-5. [DOI] [PubMed] [Google Scholar]
  10. Graham N. M., Zeger S. L., Kuo V., Jacobson L. P., Vermund S. H., Phair J. P., Detels R., Rinaldo C. R., Saah A. J. Zidovudine use in AIDS-free HIV-1-seropositive homosexual men in the Multicenter AIDS Cohort Study (MACS), 1987-1989. J Acquir Immune Defic Syndr. 1991;4(3):267–276. [PubMed] [Google Scholar]
  11. Hellinger F. J. The use of health services by women with HIV infection. Health Serv Res. 1993 Dec;28(5):543–561. [PMC free article] [PubMed] [Google Scholar]
  12. Holmberg S. D., Conley L. J., Buchbinder S. P., Judson F. N., Bush T. J., Katz M. H., Penley K. A., Hershow R. C. Use of therapeutic and prophylactic drugs for AIDS by homosexual and bisexual men in three US cities. AIDS. 1993 May;7(5):699–704. doi: 10.1097/00002030-199305000-00014. [DOI] [PubMed] [Google Scholar]
  13. Ickovics J. R., Rodin J. Women and AIDS in the United States: epidemiology, natural history, and mediating mechanisms. Health Psychol. 1992;11(1):1–16. doi: 10.1037//0278-6133.11.1.1. [DOI] [PubMed] [Google Scholar]
  14. Jeffe D. B., Meredith K. L., Mundy L. M., Fraser V. J. Factors associated with HIV-infected patients' recognition and use of HIV medications. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Dec 1;19(4):350–360. doi: 10.1097/00042560-199812010-00005. [DOI] [PubMed] [Google Scholar]
  15. Lang W., Osmond D., Samuel M., Moss A., Schrager L., Winkelstein W., Jr Population-based estimates of zidovudine and aerosol pentamidine use in San Francisco: 1987-1989. J Acquir Immune Defic Syndr. 1991;4(7):713–716. [PubMed] [Google Scholar]
  16. Liang K. Y., Zeger S. L. Regression analysis for correlated data. Annu Rev Public Health. 1993;14:43–68. doi: 10.1146/annurev.pu.14.050193.000355. [DOI] [PubMed] [Google Scholar]
  17. Moore R. D., Hidalgo J., Sugland B. W., Chaisson R. E. Zidovudine and the natural history of the acquired immunodeficiency syndrome. N Engl J Med. 1991 May 16;324(20):1412–1416. doi: 10.1056/NEJM199105163242006. [DOI] [PubMed] [Google Scholar]
  18. Moore R. D., Stanton D., Gopalan R., Chaisson R. E. Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med. 1994 Mar 17;330(11):763–768. doi: 10.1056/NEJM199403173301107. [DOI] [PubMed] [Google Scholar]
  19. Nichol M. B., Stimmel G. L., Lange S. C. Factors predicting the use of multiple psychotropic medications. J Clin Psychiatry. 1995 Feb;56(2):60–66. [PubMed] [Google Scholar]
  20. Palella F. J., Jr, Delaney K. M., Moorman A. C., Loveless M. O., Fuhrer J., Satten G. A., Aschman D. J., Holmberg S. D. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998 Mar 26;338(13):853–860. doi: 10.1056/NEJM199803263381301. [DOI] [PubMed] [Google Scholar]
  21. Public Health Division New South Wales Public Health Bulletin -Discussion Paper 2000. N S W Public Health Bull. 2000 Nov;11(S-3):1–16. [PubMed] [Google Scholar]
  22. Schechter M. T., Hogg R. S., Aylward B., Craib K. J., Le T. N., Montaner J. S. Higher socioeconomic status is associated with slower progression of HIV infection independent of access to health care. J Clin Epidemiol. 1994 Jan;47(1):59–67. doi: 10.1016/0895-4356(94)90034-5. [DOI] [PubMed] [Google Scholar]
  23. Schulman K. A., Rubenstein L. E., Chesley F. D., Eisenberg J. M. The roles of race and socioeconomic factors in health services research. Health Serv Res. 1995 Apr;30(1 Pt 2):179–195. [PMC free article] [PubMed] [Google Scholar]
  24. Siegel K., Gorey E. HIV-infected women: barriers to AZT use. Soc Sci Med. 1997 Jul;45(1):15–22. doi: 10.1016/s0277-9536(96)00303-6. [DOI] [PubMed] [Google Scholar]
  25. Simon P. A., Hu D. J., Diaz T., Kerndt P. R. Income and AIDS rates in Los Angeles County. AIDS. 1995 Mar;9(3):281–284. [PubMed] [Google Scholar]
  26. Solomon L., Stein M., Flynn C., Schuman P., Schoenbaum E., Moore J., Holmberg S., Graham N. M. Health services use by urban women with or at risk for HIV-1 infection: the HIV Epidemiology Research Study (HERS). J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Mar 1;17(3):253–261. doi: 10.1097/00042560-199803010-00011. [DOI] [PubMed] [Google Scholar]
  27. Stein M. D., Piette J., Mor V., Wachtel T. J., Fleishman J., Mayer K. H., Carpenter C. C. Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons. J Gen Intern Med. 1991 Jan-Feb;6(1):35–40. doi: 10.1007/BF02599388. [DOI] [PubMed] [Google Scholar]
  28. Turner B. J., Markson L. E., McKee L. J., Houchens R., Fanning T. Health care delivery, zidovudine use, and survival of women and men with AIDS. J Acquir Immune Defic Syndr. 1994 Dec;7(12):1250–1262. [PubMed] [Google Scholar]
  29. Vermund S. H., Hein K., Gayle H. D., Cary J. M., Thomas P. A., Drucker E. Acquired immunodeficiency syndrome among adolescents. Case surveillance profiles in New York City and the rest of the United States. Am J Dis Child. 1989 Oct;143(10):1220–1225. [PubMed] [Google Scholar]
  30. Ware J. H., Lipsitz S., Speizer F. E. Issues in the analysis of repeated categorical outcomes. Stat Med. 1988 Jan-Feb;7(1-2):95–107. doi: 10.1002/sim.4780070113. [DOI] [PubMed] [Google Scholar]
  31. Zeger S. L., Liang K. Y. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986 Mar;42(1):121–130. [PubMed] [Google Scholar]

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