AIDS Support Services Facilitate Entry, Retention in Primary Care;
HRSA Research Is Focus of AIDS Care Journal Special Issue

Eight new studies funded by the Health Resources and Services Administration (HRSA) come to a single conclusion: support services are essential to helping poor or uninsured people living with HIV/AIDS enter into primary health care and remain in treatment. 

The studies, published in a special supplement of the journal AIDS Care, were released today in Washington, D.C., during the 2002 Ryan White CARE Act Grantee Conference. The biennial conference is the largest gathering of HIV/AIDS health care providers in the country. 

“These studies confirm what patients had told our service providers -- that ancillary services contribute to early and consistent care for people living with HIV,” said HRSA Administrator Elizabeth M. Duke, Ph.D.  “Case management, mental health and substance abuse treatment and counseling, advocacy and other services all play an integral role in the high-quality health care that we provide.”

When Congress reauthorized the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1996, lawmakers directed HRSA, an agency of the Department of Health and Human Services, to evaluate the effectiveness of programs in reaching individuals living with HIV/AIDS who are poor, uninsured or underinsured.  These studies are a result of that mandate.

Seven of the eight studies were conducted by Ryan White CARE Act grant recipients and examine support services provided in California and North Carolina, as well as in New York City, Chicago, Boston, New Orleans, and St. Louis, Mo.  The eighth was done by HRSA researchers. All researchers examined two fundamental questions:  

• Are clients’ receipt of ancillary services associated with their entry into primary care in non-emergency room settings? and

• Do clients’ receipt of such services correlate with their retention in primary care?

The seven grantee studies and authors are:

• “The Impact of Ancillary HIV Services on Engagement in Medical Care in New York City,” by Peter A. Messeri, Ph.D., David M. Abramson M.P.H., Angela A. Aidala, Ph.D., Fleur Lee, M.P.H., and Gunjeong Lee, M.A.;

• “HIV Multidisciplinary Teams Work: Support Services Improve Access to and Retention in HIV Primary Care,” by Kim Stieglitz, D.N.Sc., R.N., Jyothi Narra, M.D., John Jasek, Lynn Green, B.A., Billie Moore, Susan Shott, Ph.D., Mardge Cohen, M.D., and Renslow Sherer, M.D.;

• “Association of Ancillary Services with Primary Care Utilization and Retention for Patients with HIV/AIDS,” by Wilson Lo, Ted MacGovern, and Judith Bradford;

• “The Impact of Ancillary Services on Primary Care Use and Outcomes for HIV/AIDS Patients with Public Insurance Coverage,” by Christopher J. Conover, Ph.D., and Kathryn Whetten-Goldstein, Ph.D.;

• “Recipients in Need of Ancillary Services and Their Receipt of HIV Medical Care in California,” by Dixie Chan, Denise Absher, and Susan Sabatier;

• “A Profile of an HIV- and Child-Specific Programme in New Orleans, Louisiana, USA,” by Manya Magnus, Norine Schmidt, Barbara Brown, and Patricia J. Kissinger; and

• “Women with HIV Infection: A Model Of University-Based Care, Training And Research,” by Linda M. Mundy, M.D., Pavani Kalluri, M.D., Karen Meredith, M.P.H., Lauren Marshall, Victoria J. Fraser, M.D., and Paul Thompson, Ph.D.

The ancillary services researchers studied -- at sites ranging from single primary health care clinics serving as few as 40 clients to statewide programs providing services through a broad array of providers -- include case management, child care, outreach, respite care, translation, transportation, mental health treatment, substance abuse treatment, food or nutritional assistance, legal assistance, and housing services. 

Seven of the studies examined the impact of one or multiple ancillary services. All but one of the studies found some positive associations between case management and primary care entry or retention.  In “The Impact of Ancillary Services on Primary Care Use and Outcomes for HIV/AIDS Patients with Public Insurance Coverage,” North Carolina researchers found no positive association between case management and primary care entry or retention among Medicaid-covered patients.

For the five primary ancillary services studied—case management, mental health services, substance abuse treatment, transportation assistance, and housing assistance—a majority of the study sites found greater positive associations between receipt of the services and primary care retention than with entry into primary care. 

The lone study that looked at the impact of all ancillary services, “A Profile of an HIV- and Child-Specific Programme in New Orleans, Louisiana, USA,” found that in the New Orleans pediatric clinic the receipt of any ancillary service was associated with retention in primary care. 

The HRSA researchers’ study -- “Associations between HIV-Positive Individuals’ Receipt of Ancillary Services and Medical Care Receipt and Retention” -- examined for the first time the five primary medical and ancillary services received by all CARE Act program clients in multiple cities and states. 

Conducted by Jill Jacobsen Ashman, Ph.D., Richard Conviser, Ph.D., and Moses Pounds, Ph.D., the study found a strong relationship between an individual’s receipt of ancillary services and their receipt of and retention in primary medical care. The study was based on data submitted by grantees to HRSA’s Client Demonstration Project. 

Specifically, they found that “clients who lack insurance are more likely than those with private or public insurance to receive safety net-funded primary medical care, which shows that the safety net is helping vulnerable populations get into care.” 

HRSA’s HIV/AIDS Bureau, which administers the Ryan White CARE Act, is sponsoring the conference to improve systems of care for people living with HIV/AIDS; help grantees comply with changes in the reauthorized CARE Act; increase grantees’ knowledge of administrative requirements; and enable them to share best practices. 

The CARE Act funds primary care and support services for individuals living with HIV disease who lack the health insurance and financial resources for their care.  While ambulatory health care and support services are the primary focus of the program, training, technical assistance, and demonstration projects are also funded. The federal investment in CARE Act programs in fiscal year 2002 was $1.91 billion. 

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