Service Delivery and Patient Outcomes in Ryan White HIV/AIDS Program-Funded and -Nonfunded Health Care Facilities in the United States

Outpatient human immunodeficiency virus (HIV) health care facilities receive funding from the Ryan White HIV/AIDS Program (RWHAP) to provide medical care and essential support services that help patients remain in care and adhere to treatment. Increased access to Medicaid and private insurance for HIV-infected persons may provide coverage for medical care but not all needed support services and may not supplant the need for RWHAP funding.

Overall, 34.4% of facilities received RWHAP funding and 72.8% of patients received care at RWHAP-funded facilities. With results reported as percentage, patients attending RWHAP-funded facilities were more likely to be aged 18 to 29 years, female, black or Hispanic, have less than a high school education, income at or below the poverty level, and lack health care coverage. 

The RWHAP-funded facilities were more likely to provide case management as well as mental health, substance abuse, and other support services; patients attending RWHAP-funded facilities were more likely to receive these services. After adjusting for patient characteristics, the percentage prescribed ART antiretroviral therapy, reported as adjusted prevalence ratio, was similar between RWHAP-funded and non-RWHAP-funded facilities, but among poor patients, those attending RWHAP-funded facilities were more likely to be virally suppressed.

A total of 72.8% of HIV-positive patients received care at RWHAP-funded facilities. Many had multiple social determinants of poor health and used services at RWHAP-funded facilities associated with improved outcomes. Without facilities supported by the RWHAP, these patients may have had reduced access to services elsewhere. Poor patients were more likely to achieve viral suppression if they received care at a RWHAP-funded facility.

Via: http://ht.ly/S9NB8 

By: Weiser J1, Beer L1, Frazier EL1, Patel R2, Dempsey A3, Hauck H3, Skarbinski J4.

• 1Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
• 2Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia2Health Information and Technology Systems, ICF International, Atlanta, Georgia.
• 3HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland.
• 4Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia.

Do Sexually Oriented Massage Parlors Cluster in Specific Neighborhoods? A Spatial Analysis of Indoor Sex Work in Los Angeles and Orange Counties, California

Social determinants of health may be substantially affected by spatial factors, which together may explain the persistence of health inequities. Clustering of possible sources of negative health and social outcomes points to a spatial focus for future interventions. We analyzed the spatial clustering of sex work businesses in Southern California to examine where and why they cluster. We explored economic and legal factors as possible explanations of clustering.

A total of 889 venues were identified. Clusters of tracts having higher-than-expected numbers of sexually oriented massage parlors ("hot spots") were located outside downtowns. These hot spots were characterized by a higher proportion of adult males, a higher proportion of households below the federal poverty level, and a smaller average household size.

Sexually oriented massage parlors in Los Angeles and Orange counties cluster in particular neighborhoods. More research is needed to ascertain the causal factors of such clusters and how interventions can be designed to leverage these spatial factors.

Via: http://ht.ly/S1gfF

By: Chin JJ1, Kim AJ2, Takahashi L3, Wiebe DJ4.

• 1Hunter College, City University of New York, Urban Affairs and Planning, New York, NY.
• 2Georgia Institute of Technology, City and Regional Planning, Atlanta, GA.
• 3University of California, Los Angeles, Urban Planning, Los Angeles, CA.
• 4University of Pennsylvania, Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, PA.