Research Activities #227, June 1999

cocktail” drugs—protease inhibitors—were first approved, uninsured people with HIV disease waited up to 4-1/2 months longer, on average, than privately insured patients to begin life-sustaining medication, according to a new national study sponsored by the Agency for Health Care Policy and Research. The study also found that HIV patients covered by Medicaid waited 3 months longer than privately insured patients to start protease-inhibitor therapy, blacks started nearly 3 months after whites, and women began about 2 months later than men, on average. But the findings of this study also contain some encouraging news—the glaring disparities uncovered at the beginning of 1996 have narrowed considerably. By the beginning of 1998, Latinos no longer lagged behind white Anglo HIV patients in five of six indicators used to determine the adequacy or inadequacy of care, and although Medicaid, uninsured, and black patients continued to lag behind their counterparts in several of the measures, the differences were not as pronounced as before. The disparity between female and male HIV patients, however, remained essentially unchanged. The findings are from the HIV Cost and Services Utilization Study (HCSUS)—conducted by RAND of Santa Monica, CA, through a cooperative agreement with AHCPR—and are based on data from a national sample of patients representing the nation’s 231,400 HIV-infected people receiving care for their disease, who were interviewed in 1996, 1997, and early 1998. The interviews focused on six indicators of access to quality care—receipt of any antiretroviral therapy; initiating, by the end of 1996, treatment with the recently developed “AIDS cocktails,” which incorporate protease inhibitor or nonnucleoside reverse transcriptase inhibitor drugs; taking drugs to prevent Pneumocystis carinii pneumonia (PCP)—a major killer of HIV-weakened patients; making at least two outpatient visits; not being hospitalized; and not visiting the emergency room (ER) for a problem that did not result in hospitalization. In early 1996, 7 of every 10 HIV patients failed to meet at least one Research Activities