Gunjeong Lee

The impact of ancillary HIV services on engagement in medical care in New York City

The advent of antiretroviral therapies in 1996 prompted an interest in the role played by ancillary services in improving access to and retention in medical care, particularly since the success of the new therapies is often contingent upon ongoing and appropriate primary medical care. Using self-reported survey data from a longitudinal representative sample of 577 HIV-positive adults in New York City, this paper explores the impact of such supportive services as drug treatment, case management, housing assistance, mental health treatment and transportation on engagement with medical care. The studys principal finding was that specific ancillary services were significantly associated with an increase in an individuals likelihood of entering medical care and maintaining appropriate medical care services for HIV, particularly when the services addressed a corresponding need.

Housing Need, Housing Assistance, and Connection to HIV Medical Care

HIV infection has become a chronic condition that for most persons can be effectively managed with regular monitoring and appropriate medical care. However, many HIV positive persons remain unconnected to medical care or have less optimal patterns of health care utilization than recommended by good clinical practice standards. This paper investigates housing status as a contextual factor affecting access and maintenance in appropriate HIV medical care. Data provided from 5,881 interviews conducted from 1994 to 2006 with a representative sample of 1,661 persons living with HIV/AIDS in New York City demonstrated a strong and consistent relationship between housing need and remaining outside of or marginal to HIV medical care. In contrast, housing assistance increased access and retention in medical care and appropriate treatment. The relationship between housing and medical care outcomes remain controlling for client demographics, health status, insurance coverage, co-occurring mental illness, and problem drug use and the receipt of supportive services to address co-occurring conditions. Findings provide strong evidence that housing needs are a significant barrier to consistent, appropriate HIV medical care, and that receipt of housing assistance has an independent, direct impact on improved medical care outcomes.

Antiretroviral therapy and declining AIDS mortality in New York City.

Objective. This study estimates the impact of Highly Active Antiretroviral Therapy (HAART) and other antiretroviral therapy combinations on reducing mortality risk for a cohort of HIV-infected persons living in New York City. Materials and methods. Data for this study come from the CHAIN project, an ongoing multiwave longitudinal study of HIV-infected persons is living in New York City (n = 700) initiated in 1994. The study sample is drawn from the clients of 43 medical and social service agencies and is broadly representative of New York City residents, who were aware of their positive serostatus at time of enrollment. Occurrences of deaths were obtained through routine field tracking and searches of death certificates and an online death registry. Information on other study variables was obtained through in-person interviews. A Cox proportional hazard model was applied to estimate the effects of medication on mortality risk. Results. Mortality rates for the CHAIN cohort dropped steadily from a high of 131 deaths per 1000 persons/year in 1995 to 31 deaths per 1000 persons/year in 1999, with the historically low mortality rates continuing through 2000. Current use of HAART was associated with a 50% reduction in mortality risk (hazard ratio = 0.51, P <0.01). Conclusions. These results demonstrate that in the case of HAART, the therapeutic benefits of an innovative but costly medical treatment are reaching populations that traditionally have poor access to quality health care.

Characterizing Medical Providers for Jail Inmates in New York State

OBJECTIVES People who are incarcerated exhibit high rates of disease, but data evaluating the delivery of medical services to inmates are sparse, particularly for jail settings. We sought to characterize the primary medical care providers for county jail inmates in New York State. METHODS From 2007 through 2009, we collected data on types of medical care providers for jail inmates in all New York State counties. We obtained data from state monitoring programs and e-mail questionnaires sent to county departments of health. RESULTS In counties outside New York City (n = 57), jail medical care was delivered by local providers in 40 counties (70%), correctional medical corporations in 8 counties (14%), and public providers in 9 counties (16%). In New York City, 90% of inmates received medical care from a correctional medical corporation. Larger, urban jails, with a greater proportion of Black and Hispanic inmates, tended to use public hospitals or correctional medical corporations as health care vendors. CONCLUSIONS Jail medical services in New York State were heterogeneous and decentralized, provided mostly by local physician practices and correctional medical corporations. There was limited state oversight and coordination of county jail medical care.