RESUMO
This article summarizes key findings from evaluation and research studies that have received financial support from the HIV/AIDS Bureau of the Health Resources and Services Administration or from Ryan White Comprehensive AIDS Resources Emergency (CARE) Act grantees. These studies suggest that the CARE Act has improved but not equalized service accessibility, quality, and outcomes for different populations living with HIV disease. Evaluations of access to highly active antiretroviral therapy (HAART) found that uninsured patients, women, people of color, and injection drug users waited much longer than others to receive the new therapies. These disparities were not uniform across study sites, suggesting that clinic characteristics and geographic location have a major influence on prescribing patterns. Once patients gained access to HAART, health insurance status made little difference in clinical outcomes.
Assuntos
Assistência Integral à Saúde/economia , Infecções por HIV/terapia , Acessibilidade aos Serviços de Saúde/economia , Assistência Médica/legislação & jurisprudência , Avaliação de Resultados em Cuidados de Saúde , Populações Vulneráveis , Síndrome da Imunodeficiência Adquirida/economia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/terapia , Terapia Antirretroviral de Alta Atividade/economia , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Assistência Integral à Saúde/normas , Estudos de Avaliação como Assunto , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Acessibilidade aos Serviços de Saúde/normas , Humanos , Área Carente de Assistência Médica , Pobreza , Estados Unidos/epidemiologiaRESUMO
In May 2000, the HIV/AIDS Bureau of the Health Resources and Services Administration convened HIV experts from throughout the country to identify new and emerging areas of research needed to guide policy and programmatic decisions on HIV service delivery to vulnerable populations. This article describes the process used to develop an evaluation/research agenda, discusses key findings and recommendations of the conference, and proposes a set of principles to guide the design and conduct of future investigations. Conference participants identified nine major evaluation/research themes that span the continuum of HIV behavioral prevention services and treatment. They recommended focusing future research on questions relevant to populations experiencing rapid rates of increase in HIV infection (for example, women, people of color, and adolescents and young adults) and considering explanatory factors at multiple levels of analysis (individual, clinician, organization, service delivery system, and environment).