Managing the Personal Side of Health Care among Patients with HIV/AIDS

Abstract

The study describes the HIV care providers' sociodemographic and medical practice characteristics and the health care services offered to patients during medical care encounters in Houston/Harris County, Texas. We used data from the pilot cycle of the Centers for Disease Control and Prevention Medical Monitoring Project Provider Survey conducted in June to September 2009. The average age and HIV care experience of the providers were 46.7 and 11.7 years, respectively, and they provided care to an average of 113 patients monthly. The average proportion of HIV-infected patients seen per month by race/ethnicity was 43.3% for blacks, 28.5% for whites, 26.6% for Hispanics, 1.3% for Asians, and 0.6% for other races. A total of 67% of providers offered HIV testing to all patients 13 to 64 years of age. Most HIV care providers (73.9%) reported that patients in their practices sought HIV care only after experiencing symptoms. Understanding the HIV care delivery system from providers' perspectives may help enhance support services, patients' ongoing care and retention, leading to improved health outcomes.

Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

“…Most articles (64/89; 72%) covered factors related to the social or community context at minimal depth. 28,38,39,44,50,51,61,74,78,84,89,96,101,110,111,117,119,126,127,141,148,149,151,152,158,159,164,168,175,180,189,192,197,198,204,207 –235 The 25 articles with a substantial focus on social or community context included those that focused on testing for disease (eg, HIV, STDs) in communities, prevention campaigns or interventions designed for communities or incarcerated populations, and communit...…”

“…The 28 articles that had a substantial SDH focus included those that discussed in-depth health care provision, health care disparities, delays or refusal to enter into care, retaining patients in care, and health care costs. 31,50,57,74,105,107,124,146,170,208,214,215,223,348 –362 The identified articles addressed health and health care in 2 main ways: (1) the use of health care services and/or health care-seeking behaviors and (2) health care access and affordability or health care provision. Additional topics included disease transmission in health care settings and health care workers as an at-risk group.…”

Systemic Delays in the Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients in Houston, Texas

“…The MMP is a complex cross-sectional survey design conducted in 23 US states and territories in which persons diagnosed with HIV (aged 18 years and older) are selected to participate. Further details on MMP and the associated sampling method have been described previously, 27,28 and detailed description of the MMP Provider Survey can be found in the study by Mgbere et al 24 and Frankel et al 29 The Houston/Harris County, Texas component of the MMP Provider Survey data was used for the current study. The survey was conducted in Houston/Harris County, Texas from June through September 2009 in collaboration with the CDC.…”

“…The demographic and medical practice characteristics of the survey participants in the current study have been presented in detail previously. 23,24 In summary, the majority of the…”

“…13,16 Whereas only few research studies have examined the extent to which HIV treatment guidelines are systematically followed by clinicians who treat PLWH, 24,25 some studies indicate significant variations in treatment patterns and practices based on years of experience, number of HIV-infected patients under care, provider demographics, and having sufficient time or ancillary support to provide counseling services. 13,16,24 Thus, the new expanded ART eligibility guidelines, [17][18][19] coupled with increased HIV testing and linkage to and engagement in care, will likely increase the size of the population of PLWH and consequently expand the number of patients for whom providers will consider initiating ART. 16 Modeling studies suggest that expanded use of ART may lower incidence and, eventually, prevalence of HIV on a community or population level.…”