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Improvement in HIV care within the VA health system has been substantial, but some disparities persist

The quality of care that HIV-infected veterans receive through the Veterans Affairs (VA) health system is similar to national benchmarks. However, important gaps and disparities in the quality of HIV care for veterans persist, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS08578).

Researchers compared the quality of care received by 3,840 HIV-infected veterans receiving medical care in 2001 and 2002 at 16 VA facilities with care received by 1,874 participants in the HIV Cost and Services Utilization Study (HCSUS). HCSUS comprises a national probability sample of HIV-positive adults who received care in the United States from 1996 to 1998.

The researchers examined outcomes that are considered to be indicators of the quality of HIV care: receipt of highly active antiretroviral therapy (HAART); prophylaxis for Pneumocystis carinii pneumonia (PCP) and Mycobacterium avium complex (MAC), both of which are opportunistic infections that can be contracted when the immune system is weakened; and screening for syphilis, toxoplasmosis, hepatitis A, B, and C infection, and dyslipidemia (HAART can elevate "bad cholesterol" and other lipids).

Similar to national benchmarks, 78 percent of eligible veterans received HAART, 65 percent received prophylaxis for PCP, and 99 percent received prophylaxis for MAC. Many eligible veterans were screened for toxoplasmosis (44 percent), syphilis (74 percent), hepatitis A (55 percent), hepatitis B (67 percent), and hepatitis C (75 percent), and dyslipidemia (67 percent). However, veterans with a history of intravenous drug use (IDU) were 39 percent less likely to receive HAART than men who had sex with men (MSM), but they were more likely than MSM to receive screening for syphilis, a condition that tends to occur more frequently in people with active drug use. Finally, veterans with fewer than three medical visits had 92 percent lower odds of receiving HAART and 78 percent lower odds of PCP prophylaxis.

More details are in "Quality of HIV care within the Veterans Affairs health system: A comparison using outcomes from the HIV Cost and Services Utilization Study," by Philip T. Korthuis, M.D., M.P.H., Henry D. Anaya, Ph.D., Samuel A. Bozzette, M.D., Ph.D., and others, in the December 2004 Journal of Clinical Outcomes Management 11(12), pp. 765-774.

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