Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics

Hirschhorn, Lisa R.; McInnes, Keith; Landon, Bruce E.; Wilson, Ira B.; Ding, Lin; Marsden, Peter V.; Malitz, Faye; Cleary, Paul D.

doi:10.1016/j.whi.2006.02.004

« Previous Next »Women's Health Issues
Volume 16, Issue 3 , Pages 104-112, May 2006

Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics

Lisa R. Hirschhorn, MD, MPH
- Harvard Medical School Division of AIDS, Harvard Medical School, Boston, Massachusetts
- Correspondence to: Dr Hirschhorn, Harvard Medical School Division of AIDS, The Landmark Center, 401 Park Drive Second Floor East, Boston, MA 02215; Phone: 617-384-9035; fax: 617-384-9037.
Keith McInnes, MS
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Bruce E. Landon, MD, MBA
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Ira B. Wilson, MD, MSc
- Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts
Lin Ding, PhD
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Peter V. Marsden, PhD
- Department of Sociology, Harvard University, Cambridge, Massachusetts
Faye Malitz, MS
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland
Paul D. Cleary, PhD
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts

Received 24 October 2005; accepted 7 February 2006.

Background

Women with HIV infection have lagged behind men in receipt of critical health care, but it is not known if those disparities are due in part to where women receive care. We examined differences in care received by HIV-infected women and men in a national sample of Ryan White CARE Act–funded clinics and explored the influence of clinic characteristics on care quality.

Methods

Record review was done on a sample of 9,015 patients who received care at 69 CARE Act–funded HIV primary care clinics that participated in a quality improvement study. Outcome measures studied were highly active antiretroviral therapy (HAART) use, HIV viral suppression, Pneumocystis jiroveci pneumonia (PCP) prophylaxis, screening, and other disease prevention efforts.

Results

Women were less likely than men to receive HAART (78% versus 82%, p < .001), receive PCP prophylaxis (65% versus 75%, p < .0001), or have their hepatitis C virus status known (87% versus 88%, p = .02) despite being seen more regularly (69% versus 66%, p = .04). Sites serving high percentages of women delivered similar or better care for both men and women than other sites. Although sites serving a higher percent of women had more support services such as case management and onsite obstetrician–gynecologists and provided Pap smears at higher rates, women at such sites remained less likely than men to receive important HIV care including HAART and PCP prophylaxis.

Conclusions

The gap in the quality of care provided to HIV-infected men and women in critical areas persists, and is not explained by the types of sites where men and women receive care.

Keywords: HIV , Quality of care , Women , Ryan White CARE Act