Document 0078
 DOCN  M9580078
 TI    Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992.
 DT    9506
 AU    Graham NM; Jacobson LP; Kuo V; Chmiel JS; Morgenstern H; Zucconi SL;
       Department of Epidemiology, Johns Hopkins University, School of; Hygiene
       and Public Health, Baltimore, MD 21205, USA.
 SO    J Clin Epidemiol. 1994 Sep;47(9):1003-12. Unique Identifier : AIDSLINE
       MED/95248387
 AB    The study aims were (i) to describe secular trends in the utilization of
       antiretrovirals, antivirals, Pneumocystis carinii pneumonia (PCP)
       prophylaxis, and antifungal prophylaxis and (ii) to determine whether
       factors such as clinical status, health services utilization, insurance
       status, income, education and race were associated with access to
       therapy. Data on utilization of therapy, health services utilization,
       income and insurance status were collected semiannually from October
       1990 through March 1992 from 1415 homosexual/bisexual HIV-1 seropositive
       men in the Multicenter AIDS Cohort Study (MACS). Prevalence of therapy
       use according to level of immunosuppression was determined at each study
       visit. Clinical AIDS was defined using the 1987 CDC definition. Factors
       associated with use of antiretroviral therapy and PCP prophylaxis were
       assessed using multiple logistic regression with robust variance
       techniques to adjust variance estimates and significance levels for
       within-person correlations of drug use over time. Prevalence of
       zidovudine use remained relatively constant throughout the study period.
       In contrast, use of didanosine (21-34%), acyclovir (23-34%) and
       dideoxycytidine (zalcitabine) (8-25%) increased in participants with
       clinical AIDS. Similar trends were seen for combination antiretroviral
       therapy, trimethoprim-sulfamethoxazole, dapsone, ketoconazole and
       fluconazole. However, reported use of aerosolized pentamidine fell.
       After adjusting for CD4+ lymphocyte count and HIV-1 symptoms, previous
       HIV-related hospitalization (OR = 1.52; 95% CI = 1.22-1.91), outpatient
       visit (OR = 2.83; 95% CI = 2.12-3.78), having insurance (OR = 1.32; 95%
       CI = 1.01-1.75), college education (OR = 1.42; 95% CI = 1.13-1.80) and
       white race (OR = 1.58; 95% CI = 1.21-2.07) were all associated with
       being on antiretroviral therapy in persons without clinical AIDS. In
       persons with clinical AIDS, having insurance (OR = 2.89; 95% CI =
       1.04-8.02) and a previous outpatient visit (OR = 11.69; 95% CI =
       1.77-77.30) were the significant variables. Factors significantly
       associated with being on PCP prophylaxis in multivariate models were
       previous hospitalization, previous outpatient visit, and college
       education (for subjects without clinical AIDS.
 DE    Acquired Immunodeficiency Syndrome/*THERAPY  Adult  Antiviral
       Agents/THERAPEUTIC USE  Cohort Studies  *Health Services Accessibility
       Hospitalization/STATISTICS & NUMER DATA  Human  Income  Insurance,
       Health/UTILIZATION  Male  Pneumonia, Pneumocystis carinii/PREVENTION &
       CONTROL  Racial Stocks  Support, U.S. Gov't, P.H.S.  United States
       CLINICAL TRIAL  JOURNAL ARTICLE  MULTICENTER STUDY

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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