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Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992
N M Graham1, L P Jacobson, V Kuo
1Department of Epidemiology, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205, USA.
Journal of Clinical Epidemiology
|September 1, 1994
Summary
This study tracked HIV therapy use in homosexual men from 1990-1992. Factors like insurance and education influenced access to antiretrovirals and Pneumocystis pneumonia (PCP) prophylaxis.
Area of Science:
- * Infectious Diseases
- * Public Health
- * Epidemiology
Background:
- * Understanding trends in Human Immunodeficiency Virus type 1 (HIV-1) treatment is crucial for managing the epidemic.
- * Factors influencing access to antiretroviral therapy (ART) and prophylaxis for opportunistic infections require ongoing investigation.
Purpose of the Study:
- * To describe secular trends in the utilization of antiretrovirals, antivirals, Pneumocystis carinii pneumonia (PCP) prophylaxis, and antifungal prophylaxis.
- * To determine if clinical status, health services utilization, insurance, income, education, and race were associated with therapy access.
Main Methods:
- * Longitudinal study of 1415 homosexual/bisexual HIV-1 seropositive men in the Multicenter AIDS Cohort Study (MACS) from October 1990 to March 1992.
- * Data collected semiannually on therapy use, health services, income, and insurance status.
- * Multivariate logistic regression used to assess factors associated with therapy use, adjusting for immunosuppression levels and clinical AIDS status.
Main Results:
- * Zidovudine use remained stable, while use of didanosine, acyclovir, and dideoxycytidine increased in participants with clinical AIDS.
- * Use of combination ART, trimethoprim-sulfamethoxazole, dapsone, ketoconazole, and fluconazole also increased; aerosolized pentamidine use declined.
- * For individuals without clinical AIDS, factors associated with ART use included prior hospitalization, outpatient visits, insurance, college education, and white race. Similar factors, plus outpatient visits, were significant for PCP prophylaxis.
Conclusions:
- * Significant increases in the use of newer antiretrovirals and prophylaxis for opportunistic infections were observed during the study period.
- * Access to essential HIV therapies was influenced by socioeconomic and healthcare utilization factors, highlighting disparities in care.
- * Continued monitoring of therapy trends and access determinants is vital for optimizing HIV/AIDS management.