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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)104-112
Number of pages9
JournalWomen's Health Issues
Volume16
Issue number3
DOIs
StatePublished - May 2006

Funding

The authors wish to thank Rebecca Joyce for her assistance in data collection, our colleagues at the Health Resources and Services Administration and the Institute for Healthcare Improvement for their support of the Evaluation of Quality in HIV Care study, and staff at the Ryan White CARE Act sites who participated in this study. This work was supported in part by grants from the Harvard Medical School Center for Excellence in Women’s Health and the Agency for Healthcare Research and Quality (R-01HS1-227).

Keywords

  • HIV
  • Quality of care
  • Ryan White CARE Act
  • Women

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health
  • Obstetrics and Gynecology
  • Maternity and Midwifery

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