Purpose: To investigate the impact of Ryan White Care Act (RWCA) funding on clinical and social outcomes in infants and children. Methods: An observational cohort study is planned of 350 children followed between 1985 -1999 in a pediatric infectious diseases clinic of a large urban hospital. The cohort will be stratified by phases of RWCA funding: pre-funding, program implementation, and program maturity; Computer databases supplemented by chart abstraction will provide information on visit/ hospitalization dates, lab values, illnesses, treatments, and clinical trials participation. Social work abstraction will identify visit dates, caregiver, client/other family needs, need type, social work activity, and date of problem resolution. Independent variables include: the three RWCA phases; Demographics (DOB, ethnicity, caregiver status); clinical care (treatment, clinic attendance, maternal use of AZT), and case management utilization and intensity. Outcomes include: clinical (slowed disease progression, increased survival, decreased number of hospitalizations/ opportunistic infections, and decline in perinatal infection); laboratory (CD4 count and low viral load maintenance and decline in viral load; and case management (access to services) variables. Within and between phase comparisons will be conducted. Analysis of temporal effects, including group-level associations of RWCA program implementation with clinical care and outcomes, and individual-level associations of case- management with clinical endpoints, will be performed using hierarchical regression procedures in the Poisson or logistic framework. The independent effect of changes in care will also be explored. Implications: The results will inform planning regarding structural approaches to HIV care that optimize clinical and social services outcomes.
Learning Objectives: At the end of this session, the participants will be able to: Evaluate methods of outcomes measurement; Assess the impact of secular trends on clinical care; and Assess the feasibility of using extant data for conducting a clinical outcomes study
Keywords: Outcomes Research, HIV/AIDS
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Lower NY Consortium for Families with HIV
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.